Newborns and Routines – the fact and the fiction!

Heidi Skudder Baby Sleep, Breastfeeding

When I was pregnant, I was confident that I would aim to help my baby get into a routine as soon as I felt like it was the right time. If you have ever attended one of my Sleep Workshops, you will know that I always advise setting up a routine for baby as it helps promote better night time sleep, established feeding patterns and just generally creates a happy and contented baby who feels relaxed with confident parents. As I say in my workshops, the right time depends on when you feel ready, for some this can be two weeks in, and for others it can be at 6 months – everyone has their own opinions on views on this, but the fact is you can actually establish a routine anytime from birth onwards.
Routines have had a negative press in recent years. The word routine is often rejected by many new parents or health professionals who believe routine to mean leaving a baby to cry and not giving it what it needs as and when the baby demands. Everyone also then has that one friend who spent the first two years of their child’s life religiously tied to the house whilst baby had their lunch time nap and therefore refuse to go down the same route themselves for fear of not being able to socialise or go out ever again.
The truth is, routines are actually incredibly positive and really can make or break the experience of becoming a first time parent. In antenatal classes, we are often given the advice that if you plan to breastfeed, you must not even think about setting up a routine, and that as a new parent you should expect your baby never to sleep, but the reality is this is not true at all! You can breastfeed your baby AND have a routine in place, routines DO NOT destroy breastfeeding. In fact, I would argue that if done in the right way, they can actually promote and nurture breastfeeding as your body and baby gets into a rhythm where both know what to expect of each other, therefore the supply and demand element of breastfeeding works beautifully. Most importantly, routines DO NOT mean that if your baby is hungry, or needs something, that you ignore it just because the piece of paper states that the feed is not due (for example). There is no part of a routine that is not flexible, and you are still 100% responding to your child’s needs.
Getting into a pattern in the early days will very much depend on feeding going well, and it is the basic routine of three hourly feeds that start off the path to creating a routine later on. Working hard to ensure your milk supply is good is a whole new topic, but if you manage to create a good breastfeeding relationship, then having good and efficient feeds, will mean that baby will then sleep well too (medical conditions aside!). From the very word go, I would wake Rupert every three hours, and feed him. As already mentioned in a previous blog, he would not latch, so for the first 2-3 weeks, our feeds would take the best part of 1.5-2 hours whilst I fed him on both sides (15 minutes on each), then topped him up, and settled him (usually at this point he had been awake 1 hour 15-30 minutes), and he would then sleep for the remainder of that time whilst I pumped and hopefully then slept myself. So our pattern looked a little as follows;
Feed (breast and then top up)
Awake time (nappy change)
Sleep (1.5 hours)

This repeated every three hours for the first couple of weeks, and was then our own little “routine” in the early days. Having this as a structure meant he took good decent feeds every few hours, and was then able to sleep soundly too. At this stage he was still in the room with us, and until we went to bed he would be in his basket in the living room. Due to his tongue tie, we still had to wake him three hourly at night time to stop the tongue reattaching, but if this had not been the case, I would have been allowing him to go four hourly during the nights (always assuming baby has reached their birth weight, which he did very quickly). Note that this three hourly pattern does rely on a baby feeding well, and there may have been times where he woke after 2.5 hours, and I would still feed him. I was not at all depriving him of anything and his needs were always fully met.
Fast forward to week seven and we are now in a more structured routine, which has developed and grown from where we were at in those early weeks when feeding was still being established and his tongue tie was still an issue. Once again, I stress that everyone is different, but for me, it was the end of week 3 when my husband had returned to work, and we were no longer having to do wound management on his tongue (which caused a lot of pain and crying for both baby and mummy), that I decided it was time to set up the bedtime routine and start aiming for a twelve hour night. Having had a conversation with my husband, we both agreed that a 7.30pm bedtime would work best so that he could still be involved in bathtime in the evenings . So off we went, from week 3 we were starting to create our own little pattern and Rupert fell into it with no problem at all. At this stage, he was still very sleepy between feeds and so his sleeps were long and unbroken. By week 5, we were following a pattern of him being awake for 1 hour and 15 minutes, sometimes 30 minutes, before then sleeping again and so our day looked something like this:
7.30am – Wake and Breastfeed
Playtime
8.45/9am – 10.30am – Sleep
10.30am – Breastfeed
Playtime
11.30am – Bottle top up (formula 60mls)
11.45/12-2.30/3pm – VIP SLEEP
3pm – Breastfeed
Playtime
4-5.30pm – Sleep (usually in pram or buggy to get out and about if we hadn’t already for one of the other sleeps)
5.30pm – Breastfeed
Playtime
6.30pm – Bathtime
6.45pm – Bottle of Expressed milk with Daddy
In bed by 7.30pm

During the night times, Rupert was waking roughly every 4 hours, so he would feed at around 11pm and then again around 3am. This has continued but he is now waking at around 11pm or midnight, and then again at 4/5am. Given he is now 6kgs (having been born at 3.6kgs), I know he is more than capable of going through the night with one feed, so we are now working to push out that second night feed so that he goes through from his first night feed to 7am…something that I am slowly doing by resettling him if he wakes before 4am, rather than feeding him. His first night feed is a bottle of formula, as I am a big fan of getting him used to this from early on so that he does not refuse it later on, and his second night feed is a breast feed. At 7 weeks, Rupert is doing incredibly well but of course we have our good and our bad days. This is exaggerated even more by his reflux, which is slowly starting to play more of a part in his days. From around 3-4 weeks I noticed he was regurgitating slightly, and as I know from working with hundreds of reflux babies in the past, by around 6 weeks it tends to come to a head and indeed at around 5 weeks we made the trip to the GP for infant Gaviscon. This seems to be doing the trick at the moment, but he is still suffering which means that day time sleeps are sometimes broken, and he does need resettling especially on a “bad” day.
So what is the secret to routines working at such an early age? My top tips on helping your baby get into a good pattern are as follows:
-Feeding has to be established – a newborn baby will not sleep if they are still hungry. If you have any doubt over milk supply, there is lots you can do to increase it and if not, think about topping up! A happy and fed baby is a sleepy baby.
-In the early days your baby will very naturally feed to sleep, as sleeping and feeding is all they do. However, from around week 2 onwards, they start to become more wakeful, so getting in some awake time before they go to sleep means that they then are more aware of falling to sleep. This is known as self-settling and contrary to some opinions, they are actually very capable of doing from very early on if given the right space to do so!
At first this would involve me settling Rupert with a cuddle and some winding, and now at 7 weeks, we walk into his room, put him into his swaddle bag, sing a few songs and then he goes down into his basket awake, but happy and content, and falls to sleep on his own. At no point have I had to leave him to cry to teach him this, because we have been doing this from the very beginning. Don’t get me wrong, this is not an easy task and in weeks 3-5, we might be returning to the room 4-5 times at the beginning of each sleep, as he would let out a little cry and we would go back to him, pick him back up and soothe him, and then put him back down. It does take perseverance, and the temptation to bring him downstairs for cuddles rather than settle him upstairs is definitely there, but on the odd occasion where we allowed ourselves to go off track (which we did once or twice!), he slept terribly and then cue the mummy guilt for making him overtired and cranky!
-Day time sleeps have been upstairs in his bedroom from the beginning of week 3 onwards. This decision was made on the back of my experience that newborns get to an age where their environment just becomes too distracting, so having their sleeps in a darker and quieter space means they sleep better, and for longer, therefore helping them get into a good daytime sleeping pattern. Again, there were occasions where he would wake early, after only perhaps half of the sleep I knew he needed, so I would spend time resettling him again, so that he got some more sleep.
We have lots of remarks on how content and relaxed Rupert seems to be as a baby, and of course I must credit this to his gorgeous personality that continues to grow each day. However, there is also another huge factor in this and that is that he is well rested, and well fed, with parents who know what he needs and a baby who gets everything he desires. There is no forcing him to do anything, there is no ignoring his needs, and in fact I think they are probably better met by him having a routine than not. AND I am still breastfeeding, with a milk supply that continues to be just what he needs and a body that knows when to produce milk and how much.
Being fully aware that things can change still, my conclusion only has to be that setting up a structure to our baby’s day has only further improved our experience at becoming new parents. I am not going to pretend that it is easy, it takes time and dedication. Nor will I pretend that I didn’t sometimes have the urge to just throw it all in and go with the flow, but the beauty of having a routine is that you can do this. We had a house full of family at Christmas, and he didn’t sleep when he was supposed to, he fed at different times and even took a nap or two on me, but that didn’t matter because after a few days we all fell back into our rhythm and have been doing so ever since. You CAN have your off days, your CAN be totally flexible, and it really is not the big scary word that it is often made up to be. It works for some and doesn’t work for others, but just knowing that it can work and that you are still responding to your baby’s needs might just help you along the way to trying it out!