The CIO (Cry It Out) Sleep Training Method: Pros and Cons

You hear your baby crying in the next room. She’s been fed, changed and bathed. You went through her typical bedtime routine and she should be asleep by now. Do you respond to her cries or do you ignore them?

The CIO method has been used to assist parents in developing healthy sleep habits for their children. Advocates of this method often state that it allows the child to develop independence, while opponents state that all this method does is teach the child that her parents can’t be relied upon for comfort.

Used properly, the CIO method is a sleep training option that can be successful. It’s not formally used before 4 months of age, though the ideal age is between 8-10 months of age. The issue is that parents assume that cry it out means allowing the child to cry without comfort when in fact it means:  1. You allow your baby to cry for a few minutes before going to offer comfort. 2. You extend the time between responding to your baby’s cries slowly so that the child gradually learns to soothe himself. When used in this fashion, the CIO method can be successful.

Really what it comes down to is the mother’s preferences in caring for her child. These preferences are often influenced by how she grew up and what she was raised to believe.

Like any controversial issue, there are pros and cons to this method:

   Pros

1. When used properly, this method can teach babies to sooth themselves.

   Cons

1. Parents often employ this method out of frustration and exhaustion, not necessarily for the baby’s own welfare. They misunderstand the use of this method and it can often cause more harm than good. When used to its extreme, this method teaches the child apathy and that its parents can’t be relied on for comfort. This results in difficulty forming trusting relationships as it grows up.
2. Additionally, it causes a baby unneeded stress when not properly administered and results in poorly adjusted adults with severe insecurities. These adults feel unworthy of love and affection, thus making it difficult to trust others.

There are instances when this method may be useful. These include:

• Breaking poor sleep association (co-sleeping, for example)
• It allows you to set limits on what you will and won’t allow your child to do.

However, CIO isn’t meant for:

• Replacing food when baby can’t sleep comfortably all night without eating
• Not when baby is hungry, wet, very sick, in pain, etc.
• Not for you to ignore the baby with the thought that it will teach them independence
• NOT a replacement for parenting when baby NEEDS you

In the end, it’s your choice. However, the best thing you can do for your baby is be properly educated on how to use your selected sleep training method. Don’t shut them away and ignore them. Find a way to make them comfortable in their own room and in their own bed, whether its a bedtime story or staying with them until they fall asleep, show your child that its okay and that you’ll always be there if they need you.

 

What Mom’s Are Talking About: Q & A From New Moms

Here are more of the great questions from my mom’s group and the answers.

Q: Is anyone feeding their LO Enfamil Newborn? How are you liking it?~Aundrea E.

A: Mine loved it. It was better for him than Similac, which upset his stomach a lot. I prefer the Enfamil. Also, Gerber has been great. He hardly spits up at all. He used to spit up nearly the whole bottle. But as they say, it really depends on your baby.

Q: So now that some of us have a few months under our belt, maybe we can use our “experience” to help those that are still waiting for their little ones. What are 3 items that are/were must haves for you?~Bertha P.

A1: Microwave bottle sanitizer, the munchkin diaper pail and the Boppy lounger.~Bertha P.
A2: Cloud b on-the-go giraffe noise maker, the miracle blanket and the rock’n’play bassinet. ~Steff Q.
A3: Swaddle blankets, swing and tiny love mobile.~Heather G.
A4: Swaddle blanket with sleep sack, Bouncy chair that vibrates, and Bumbo seat.~Tiffany C.
A5: Sleep sack, swaddle blankets with velcro, a swing with music, bouncy seat. Oh and gripe water really helpedu ntil we figured out he was sensitive to lactose!~Amy K.
A6: Microwave sanitizer, boppy aand bouncy chair.~Kellie R.
A7: Boppy nursing pillow, pack n play with bassinet only, burp cloths.~Brittany W.
A8:  Target nursing bra, Any Medela double breast pump & Baby Einstein tummy tim mat.~Jessica C.
A9: Nipple shield, boppy pillow and swaddle sleep sack.~Alissa A.
A10: Stroller, 3-in-1 playpen, convertible rocking chair, his plush frog with rattle.~Gina C.
A11: Swing, swaddle and my nose frida.~Stephanie L.
A12: Swing, boppy, bottle sterilizer and bottle warmer, gel pads for breastfeeding.~Tara F.

Q: My poor baby has chicken pox. She got the Wednesday or Thursday. She’s 13 weeks.

A: I looked it up and you can use calamine lotion as its safe for babies. But you could also use Gentle Naturals Baby Itch Relief Cream or Aveeno Anti-Itch. I’d recommend the las as I have lots in stock from baby shower gifts. I’ve been told it’s great for itchy skin. Definitely put mitts on her hands. Maybe tie ribbon around the bottom so she doesn’t wiggle out of them…but not too tight. Don’t want to cut off circulation. Avoid scratchy fabrics. Cotton will be the most soothing for her and be sure the clothes are loose and possibly a bit baggy so they don’t cause more discomfort. If you can, sleep with the air conditioning cranked a little cooler. A house that’s too warm may irritate the pox and make her crankier. Also, light cotton blankets would be more soothing. If you wanted, you could even use the anti-itch lotion to give her a gentle massage (more like rubbing lightly in circles over her skin). Places where there are no pox you might be able to apply a bit more pressure. Sing to her. A pacifier might help at this time if you don’t already use one. Also, if you breastfeed, there’s the option of maybe letting her suckle even if she’s not eating as it may sooth her to sleep. Mainly: keep her cool, keep her comfortable and keep her calm.  

 

Breastfeeding vs Formula Feeding: The Pros and Cons

The debate between breastfeeding and formula feeding has been going on pretty much since the first formula mix came onto the scene. It’s yet another of the major decisions mothers make before their baby is born. Which is right for you and your baby? That is, of course, up to you. But there are pros and cons to both possibilities. Here are some of them:

BREASTFEEDING: PROS

• Gives your baby antibodies that are said to protect from allergies.
• Boosts your baby’s immune system until they build up their own antibodies.
• In general boost your baby’s health.
• Gives you and your baby one on one bonding time.
• Gives your baby a feeling of security.
• Gives you an excuse to study your baby’s face and behaviors.
• Doesn’t require bottles, formula or bottle cleaning equipment.
• Ready made.

BREASTFEEDING: CONS

• Less sleep until baby begins sleeping through the night.
• Difficult in a public setting if you’re shy or modest.
• It’s difficult to master.
• Sore nipples.

BOTTLE-FEEDING: PROS

• Easier for travel
• If you’re unable to breastfeed, the next best thing.
• Two or more people can take turns feeding the baby.
• You can still study your baby.
• Not to difficult to mix.
• Allows everyone to bond with baby.

BOTTLE-FEEDING: CONS

• Requires lots more cleaning and prep equipment.
• Not an exact replica of breastmilk.
• Doesn’t contain the same antibodies as breastmilk.

No matter which you choose, don’t let others guilt trip you for not breastfeeding. Formula fed babies grow up to be just as healthy and normal as breastfed babies. Most of it really is only a matter of preference. Good luck!

 

Typical Questions…Not the Answers You’d Expect to Hear

I was reading some of the questions asked by moms in my BabyCenter.com group and realized that these moms were in fact asking some great questions, so I’ve decided to make it the topic of today’s blog, as from the title, typical questions that moms ask that have unique answers.

Q: How old we’re your babies when you introduced the exersaucer and the jumper? — Heather G.

A: I’d recommend waiting until your little one can support their head pretty well and possibly even when they can bear weight/push up with their legs. Possibly somewhere between 4-5 months.

Q: Does anyone else here bed-share? Just wondering since I don’t get a lot of “nice comments” when it comes up with friends and family. LO is almost 3 months and she’s absolutely fine sleeping with us. — Umm T.

A: I do my afternoon naps that way. But I usually use the couch. I’d be careful with that though, not necessarily because she’s not safe in bed with you or that stuff haters spout. I’ve seen it with my niece, who is now almost 4 years old. It’s hard to get them to sleep in their own bed after they’ve been in yours for awhile. It scares them because they’re not used to sleeping alone. So long as you and SO don’t move around in your sleep too much though, it would probably be a good idea until her feedings are more spaced out, especially if you’re EBF. That saves both of you the energy of getting up. I’d have a cart with changing supplies, outfits and a few warm blankets nearby so you don’t have to get up and go far at all. Also, maybe put a waterproof cover on your mattress for her accidents. And as hard as it is, once she’s sleeping through the night, graduate her to her crib. It will foster independence. I like napping with my LO, but most of the time he sleeps by himself in his playpen.

Q: Ugh. My baby boy caught my nasty chest cold. Any other mamas have experience with their LOs being sick and things that helped? — Katie K.

A: The best thing that you can do is give him Tylenol. If he’s under 2 years of age, use this chart for the right dosage. That’s best for a fever. I also took our small bathroom and turned the shower the hottest it would go, closed the door and used the steam to clear out his sinuses. Or you could just use a cold air humidifier in a bedroom with the door closed. Also, if he has any nose stuffiness, use Little Noses (Either drops or spray. Personally, I recommend the spray.) twice on each nostril 2-3 times a day (if you use the steam shower, use little noses before then use his little bulb to suck out the boogies). Vicks baby worked for me too, but I was told to just use a little at first in case he’s allergic to one of the ingredients.

Q: Has anyone made the transition from pack n play “bassinet” to full size crib? My LO will be 4 months old and although I’d rather him sleep in our room forever, I guess it’s time for him to move in to his own room/crib soon. I’m a little anxious about him not being right next to me and also about how he’s going to do. — Tara F.

A: If you’re not comfortable with co-sleeping, don’t feel pressured. I just took the bassinet off and started laying him in the pack and play. Mine has a mattress that hangs so it’s not too far to reach in for him. I’d recommend these kinds of pack n’ plays.

Q: Am I the only one that is looking forward to going back to work? I go back in a week and a half and am super excited. I went out a month early on bed rest (Jan 16th) and feel like I have missed so much fun. I’m a school library media specialist and have been keeping up on the blogs and technology trends and I can’t wait to get there and play with it all. I also miss my staff and students. I know I will miss her, not work late, and my days go by so fast that it will barely feel like I’m gone. I feel like I am not the best mom and I have to justify myself when I tell people I am excited since everyone assumes I am dreading it (and most people do). Maybe I just know that it’s only for 6 weeks and then it’s summer. — Holly T.

A: You can be both, honey. I’m excited to be getting back out into the job market, but at the same time, I know I’ll miss my LO like crazy.

Q: I was curious if anyone has quit breastfeeding and restarted again. I’ve researched it and I’ve found that re-lactation is possible and I think I’m going to try it. I quit about a week ago due to an emotional breakdown from being exhausted. I was exclusively pumping due to latch issues so I’m going to give it another shot. Has anyone else tried this? — Kellie R.

A: Well, I slowed down with it and am still working to rebuild my supply. Feed your LO from the breast each feeding and supplement with formula. If you can afford it, there are companies out there that you can rent a hospital grade pump. This will help you drain more. You should make sure your breasts are as empty as you can get them. This tells your body “Hey, I need more here! Start working!” And trying some of the other suggested remedies can’t hurt either. Beer does supposedly increase blood flow, so it makes sense that it would increase your supply. But finish the beer AT LEAST TWO HOURS before the next feeding to allow it time to leave your system. I wouldn’t recommend drinking beer but once a day or every couple of days. If you drink too much, you might get sick and it is also more likely that it will still be in your system when baby eats. A little unconventional, but it sometimes works for me. Also important—be sure you’re getting enough liquid. Gatorade is good because the electrolytes re-hydrate you. Another good drink is milk. Drink milk to make milk. I’d also avoid drinking a lot of caffeine, as it absorbs water and dehydrates you. Another good thing to avoid is mint in any form. It’s supposed to also absorb a lot of water and make you thirstier. Keep it up and good luck!

Q: I have a stomach/pregnancy question. In my first trimester, I had a severe morning sickness, almost every food made me sick, but two of the big ones were milk and orange juice. Since I hit the second trimester everything became better, I have been able to eat and have come back to work and to the gym. It has been great. But today because everything was going so well, I decided to try again a bowl of cereal with milk. I am able to eat yogurt, ice cream even decaf mocha; but 5 minutes later after I finished my cereal, everything came out. I don’t understand, did I became lactose intolerant or what? I am not going to be able to drink milk again? After I ate a toast and was fine, but then I had a sip of water and it made me sick again. I don’t want to be all sick again. Any ideas?—Isabel D.

A: It happens. I had trouble with dairy when I was pregnant with my son. I’d recommend just taking it easy the milk. cheese, yogurt and your mocha should be okay. Funny enough, I never had trouble with the Starbucks flavored coffees either. Then again, now that I’ve had my son, I drink milk by the glassfuls and go through nearly two gallons in a week. If it continues, maybe check with your primary care physician or a specialist.

Q: To those of you breastfeeding, if/when did you introduce a pacifier to your LO? — Mandy S.

A: I’ve heard that the whole “nipple confusion” thing is a croc. Honestly, my LO had bottles from day one b/c he was a preemie. It took some time and effort, but he can latch now with no problems. No nipple confusion. He knows which is which and did by about 2 weeks.  

Q: Breastfeeding mamas—any of you drink coffee? If so, do you do decaf or regular and how much? I’m dying to have it again but I keep hearing conflicting things about the caffeine. Does it affect LO’s sleep at all? — Katie K.

A: Coffee is okay in moderation. I’d recommend decaf, though. Tea and soda are also good substitutes. Tea with no sugar is a good one for limiting your LO’s sugar intake and soda has a better taste to it for some people. I would recommend limiting it to three or fewer cups a day, though. A certain amount enters your breast milk and your baby can’t excrete and break it down very easily, especially early on. But watch for the following signs: irritability, jitteriness, agitation and problems sleeping. Every LO tolerates it differently. Check out the chart in this article. It gives you an estimate of how much caffeine is in certain drinks. From this chart, I’d recommend no more than 600mg of caffeine a day. Personally, I’d stick around 350mg.

Q: I was wondering when and if some of you ladies have started putting cereal in their LO’s bottle. — Kim N.

A: Yeah, I’ve heard that you shouldn’t do that. I’m not planning to with my LO. The formula and solids should be plenty. I’m going to use a food processor to make the solids myself since it’s recommended to introduce him to one fruit/veggie at a time, which makes it easier to catch allergies.

 

Circumcised or Uncircumcised?

One of the many questions that you may be asked at some point during your hospital stay: “Do you want him circumcised?” Some parents have a strong opinion one way or the other, based on any number of factors, while others have no preference because they’ve never really thought about it or they want to make an informed decision which takes all of the facts into consideration. Either way, it’s a decision that you will make more than likely within the first week of your son’s life.

ARGUMENTS FOR CIRCUMCISION:

1. Cleanliness. Research suggests that this procedure reduces the risk of AIDS/HIV and penile cancer as well as making it easier to clean.
2. Culture. Religious tradition could mean pressure to follow the mandates of that religion. Also, many parents decide to circumsize their sons because other male family members on either or both sides are circumcised. Additionally, circumcision is commonly practiced in some societies and is even seen as a rite-of-passage in a few.

ARGUMENTS AGAINST CIRCUMCISION:

1. Cruelty. Opponents of circumcision point out that whether or not the baby remembers this procedure, it still causes them unnecessary pain and emotional distress, bordering on barbaric.
2. Complications. This, like any other procedure, isn’t without its risks. Infections, bleeding and deformity aren’t entirely unheard of, even if it is performed by a practitioner experienced in this procedure.

In the end, the decision is up to you as to what’s right for your son either based on the factors above or your own reasons. Only you can know what’s best for your child. But it’s recommended that the decision be made well in advance of his birth, so mother doesn’t have to add this decision to the many already undoubtedly sitting on her plate. If you do decide to circumcise your son, take the following into consideration.

GENERAL QUESTIONS

1. When should my son be circumcised? It is recommended that you wait until a week after your son’s birth (until he has at least regained his birth weight). The delay will allow doctors to assess if there is an issue that would make circumcision unwise to pursue (such as if your son has a condition called anemia, which means he bleeds easily and can have extensive blood loss from thin blood). If your baby was born prematurely, some doctors might not perform the procedure until he reaches the point where he would have been full term (more than likely his due date or close to it). It’s recommended that it be performed before he’s 3 months old and definitely before 6 months old.
2. Who should circumcise my son? Generally, it’s recommended that you choose someone who has extensive experience performing this procedure. I elected to have my pediatrician do it. She did a magnificent job and the wound has healed marvelously.
   
3. Will my insurance cover the procedure? This varies from provider to provider, so definitely call yours prior to scheduling the appointment. Cost may factor into your decision as to whether you have it performed. For my husband and I, it was important enough to us that we decided we would find the money if we had to. Fortunately, our provider paid for 80% of the cost and we were left to pay only 20%, which amounted to about $87. If you’re lucky, you will have met your maximum out-of-pocket with the combined costs of your hospital stay, all those wondeful drugs they gave you during delivery, the pediatricians and nurses who spent all that time caring for your little one while you slept and your obstetrician’s charges for services rendered and you won’t have to pay a dime.
   
4. What if I don’t have insurance? If you don’t have insurance, it might be worth it for you to check into AHCCCS or your state’s form of government-subsidized medical assistance, though I’d be careful with this as you may have to prove that the procedure is medically necessary and that can be tricky.

BEFORE THE SURGERY

1. What are some ways that I can prepare my son for the surgery? Bath your son as usual right before the surgery. Be sure to wash his little wee-wee. Also, it’s recommended that you change his diaper just before the operation and keep a clean one on hand for after as well. Additionally, feed him normally up to an hour before the surgery.

METHODS OF CIRCUMCISION

1. What are the most common methods of circumcision and how are they performed? The most common methods are Plastibell, Gomco and Mogen. All methods are preceded by either a shot of anesthetic to the base of the penis or a cream that is applied for pain management. Some doctors even offer a sucrose pacifer to comfort him. Post-surgery pain shouldn’t last for more than a day. For the Plastibell method, a plastic ring is tied around the tip of the penis. The foreskin is then removed and the ring stays in place to prevent bleeding after the surgery. It should fall off 4-10 days afterward. Clean the penis by washing three times daily or during diaper changes. For the Gomco or Mogen methods, take off the gauze and petroleum dressing 48 hours after the surgery and, as with the Plastibell method, clean the penis by washing three times daily or during diaper changes. 

AFTER THE SURGERY

1. The tip of my son’s penis is blue. Is something wrong with it? No. In fact, the reason that it appears blue is the veins underneath the surface. These veins are more visible in babies because they haven’t yet built up their store of fat and muscle. As they mature, these stores will increase and the veins will be less obvious. (A fact that I learned from experience when I rushed my son to the emergency room in the middle of the night over this very thing.)
2. What are the signs and symptoms that my son’s circumcized penis is becoming infected? While a blue tip is nothing to worry about and a little redness and swelling is to be expected (he just got his wee-wee cut at, for cripe’s sake!), if any part of the cut line is more swollen or red than the rest or if there is a puss-like discharge and crustiness accompanied by a foul odor and a fever higher than 100.4 taken rectally, there is a chance it is infected. If the Plastibell method was used, a dark brown or black area is absolutely normal and will disappear after the ring has fallen off. Also, the skin under the string may become soft and yellow, like the umbilical cord stump. Again, this is no cause for alarm. If in doubt, schedule an appointment with your doctor to have it examined. (On a side note, if you have any concern, take him in. Many new mommies fret over the smallest things with their little ones, so you’re not alone. A good pediatrician will understand this and will be happy to take the time to assuage your fears. As I always say, better safe than sorry. You may feel silly in the short term, but the relief will overwhelm any embarrassment.)
3. How can I prevent my son’s circumcision from becoming infected? Most doctors will prescribe you an antibiotic as a precaution, though its not common practice. Don’t be afraid to ask your doctor for this antibiotic if they don’t offer it. Again, better safe than sorry. Nothing is silly when it comes to your little one’s health.
   
4. How do I clean my son’s circumcision to prevent it from becoming infected? Use either Q-tips or cotton balls to first clean the cut line then to carefully apply petroleum jelly to the cut line all of the way around as well as the tip each time you change his diaper. This will promote healing, prevent his wee-wee from sticking to his diaper (ouch!) and prevent the formation of what is called a “skin bridge”. I’d recommend Q-tips because they allow you to get the jelly into the little places underneath the tip and it is in general an easier tool to handle. Use caution when bathing his penis following the surgery. If the dressing to the penis (if any is applied) has not fallen off within 24 hours, soak it in warm water. Remove the dressing slowly and if you feel any resistance, apply a little more warm water and allow the water to soak off the clotted blood before continuing. Once the dressing is off, give your son daily baths. Wash carefully around his wee-wee.
5. Is there a way for me to make the healing process less painful for my son? Yes. You can provide him with liquid Tylenol at your doctor’s discretion. For babies 6-11 pounds, the recommended dosage is 1.25mL in a syringe and for babies 12 to 17 pounds, the recommended dosage is 2.5mL in a syringe. ALWAYS USE A SYRINGE TO MEASURE THE DOSAGE. NEVER GUESS. As the recommended dosage is based on WEIGHT not AGE, SEEK MEDICAL ADVICE BEFORE ADMINISTERING ANY DOSAGE AS TYLENOL CONTAINS ACETAMINOPHEN, WHICH CAN BE HARMFUL IF THE INCORRECT DOSE IS GIVEN. Don’t confuse INFANT DROPS with INFANT/CHILDREN’S LIQUID as the drops are three times more concentrated. Also, don’t exceed more than five doses in 24 hours and NEVER give acetaminophen to an infant taking other medications without your doctor’s consent. If you’re looking for a low-cost alternative, most store brands are okay. Just be sure that you compare the ingredients of both the brand name and the store brand. If they’re the same, then its a safe bet that the store brand will work just as well. As far as how to administer, press gently on the plunger and give him a drop or two at a time. If you try to give it to him all at once, he’ll only spit out the majority of the medicine, meaning you’ll have to administer more to compensate. 
6. What are some other ways I can comfort my son after his circumcision? It definitely helps for him to be suckled or given his bottle afterward. Also, cuddle and reassure him as much as you can. He finds great comfort in your voice so talk to him and sing to him. Another trick I’ve found works for almost any incidence of fussing or discomfort, try a gentle “ch-ch-ch-ch-ch-ch-ch” sound repetitively. The noise is soothing, a reminder that you’re there.
7. What else can I expect while the circumcision is healing? A little blood or staining of his diaper for a few hours afterward is normal. However, as a guideline, using the thumb and index finger, make a ring around the top of the penis and squeeze tightly for FIVE MINUTES. If the bleeding does not stop contact the doctor immediately for advice or go to the nearest ER. Additionally, if stitches were used, they should fall off withing 7-10 days and don’t require any special care.

Notify your doctor immediately if:

• There is persistent bleeding
• The plastic ring slips onto the shaft of the penis
• There is excessive swelling
• Urine drips out of the penis
• The ring has not fallen off within 14 days of surgery
• The baby fails to settle

CARING FOR THE UNCIRCUMCISED PENIS

If you decide not to circumcise your son, here are some easy tips for ensuring cleanliness and good hygiene:

You don’t need to pull back the foreskin for the first year of life. Once he’s one or two years old, you can partially retract the foreskin for cleaning. Pull it back gently, never forcefully, and wash it with soap and water. Your son can learn to do this for himself once he reaches age five or six.

So in the end, no matter which option you go with, staying informed in the care of his little wee-wee is the best thing you can do for him. Remember, if your son has a fever of 100.4 or higher taken rectally or shows any signs of infection, contact your doctor IMMEDIATELY.

SOURCES REFERENCED

1. Julie Green. Circumcision: Arguments For and Against. October 23, 2010. Parenting Squad. <http://parentingsquad.com/circumcision-arguments-fore-and-against>
2. The Gilgal Society. Preparation and After-Care for Your Infant’s Circumcision. September 2004. <http://www.circinfo.com/prepandcare/icc.html>
3. The Permanente Medical Group, Inc. Newborn Circumcision Information. September 11, 2004. <http://www.permanente.net/homepage/kaise