This, in its entirety, is a question and reply found in a 'throwaway' journal
called "Contemporary Pediatrics", Vol 16, No 8, August 1999, pg 34.  I
wondered what lactnet subscribers would have to say about it.  I am planning
on composing a letter to this publication about Dr. Carey's answer.
Linda L. Shaw MD FAAP

Infant Needs Skin Contact With Mother to Sleep
Q:  How do I advise the mother of a 9-week-old who will not sleep in her
crib?  As a newborn the infant had physiologic jaundice, which was
exacerbated by difficulty breastfeeding.  On the advice of a lactation
consultant, mother and baby began sleeping "tummy to tummy" with a lot of
skin contact to facilitate breastfeeding.  Now the baby will sleep only if
she is lying on top of someone, and the mother is exhausted.  If the parents
put the baby in her crib, she screams.  The mother has tried letting her "cry
it out," going in after five minutes, then after longer and longer periods to
pat her on the back.  The baby finally falls asleep 30 to 40 minutes later
when she is exhausted, sleeps for 40 minutes, then wakes and screams some
more.  This goes on all night.
(The name of the Dr. who submitted the question.)

A:  Two pieces of background information would be of interest.  Doesn't the
lactation consultant know that the American Academy of Pediatrics and similar
responsible organizations advise against allowing young babies to sleep in
the prone position because of the risk of sudden infant death syndrome?  The
consultant's advice may have been helpful in the short term, but it has
resulted in a habit that must be undone.  One also has to wonder about the
extent to which the parents' concern about the infant's vulnerability,
because of jaundice, feeding problems, and perhaps other issues, are making
it hard to set reasonable limits on the infant's demands.
    This brings us to the management advice.  A reasonable first step would
be to check the baby's weight to make sure that she is sufficiently
nourished.  It might also be helpful to have the mother keep a diary of how
she handles the infant during a two- or three-day period.  Gradually
withdrawing attention, which the mother already is trying, is probably the
best strategy and needs only to be pursued more resolutely for a few days
until the baby gets used to going to sleep alone.  Some parents say that
putting the baby in the crib on or beside a heating pad or hot water bottle
facilitates the transition away from parental body warmth.  Since the mother
soothes the baby by patting her on the back, the baby must be sleeping on her
stomach. Discourage this right away.
(Answer given by William B. Carey MD, Philadelphia, PA, Clinical Professor of
Pediatrics, University of Pennsylvania School of Medicine, and Director of
Behavioral Pediatrics, Division of General Pediatrics, Children's Hospital of
Philadelphia)

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