Pediatrics Study on White Noise: Sounding Off on Sound Machines

I make no secret of the fact that I love white noise because it’s immensely helpful in helping your children cry less and sleep better. It’s pretty much the only “no fail” baby sleep tool at your disposal. Seems simple enough: buy one of the many commercial baby white nose machines and turn it on. No brainer, right? Well today Pediatrics published study on white noise saying that the cute little baby white noise machine you got at your baby shower is too loud.

The study took 14 infant sound machines (those marketed specifically for use with babies), turned the volume up to the loudest level, and measured the sound levels at three distances designed to approximate being hung directly on the crib rail, table-side next to the crib, or across the room from the crib. According to these measures, all sound machines were above the recommended volume of 50 dB when measured from crib or table-side distance, and some were even reaching levels of 85+ dB.

Is this too loud?

Yes. This is too loud.

The study does a great job of highlighting the fact that some devices marketed for use with infants are producing noise that is too loud. Sadly they don’t specify which devices they tested so if you’re wondering if one of these problematic devices is the exact one you’re using right now the answer is, “Who knows.”

The New York Times has a great writeup on this. The author asked some of the leading manufacturers of baby white noise machines if they could specify the volume output of their devices. Graco declined to answer (bad move Graco, it makes you look like you have something to hide n’est-ce pas?).

Marpac (device manufacturer) did respond to the NYT reporter saying this:
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Michelle Landesman, the customer care director at Marpac, said that the company’s Dohmie sound conditioner for babies has a decibel range of 50 to 75. “Our measurements are only taken six inches away from the machine, and that’s obviously much closer than we’d recommend,” she said.
[/pullquote]Probably by this point you’re probably feeling like this whole white noise thing is a mess and better to stop using it entirely because…why risk it? I hear you. Sometimes science is scary. But before I start making staid references to babies and bathwater let’s take a look at what we know….
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  • The study does not say that white noise is bad, it said that many baby white noise machines are too loud and that is bad.
  • White noise devices marketed for use with babies are, if set to the loudest volume, likely surpassing the 50 dB guideline.
  • Using white noise of appropriate volume has many scientifically documented benefits to your child.
  • Dr. Karp maintains that the use of white noise, used appropriately, is just fine. In the NYT article, Weissbluth backs it up too.

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The issue isn’t that white noise is harmful, the issue is that some of the gadgets we’re using are probably too loud. They might be OK if you turn down the volume or place them more than 200 cm away from the crib.

You want to use white noise that is no louder than 50 dB, approximately the volume of somebody taking a shower. As a comparison, normal human conversation is 60 db, so 50 dB is quieter than just about everything that you and your baby do during the day. Also, it’s important to note that babies don’t hear like you do. Your baby as an auditory threshold of at least 25-35 db until their first birthday (adults have an auditory threshold of 0 db) so 50 dB is a very conservative volume and sounds far more quiet to your child than it does to you.

But even so, how can we make sure we’re not overdoing it?

Use White Noise Safely

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  • Never put a white noise machine in or immediately next the crib.
  • If you’re using a baby white noise device you should probably assume that it’s too loud if set to the highest volume. (Would be super helpful if they simply listed the products tested no?)
  • Check the ambient noise of white noise in your child’s room with a decibel meter app.*
  • “Reality check” the volume where your child sleeps: does it sound like the volume of somebody taking a shower to you?
  • Talk to your pediatrician about it.

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*Testing Decibels

There are a variety of apps to test the volume of sound. I can’t make any claims to their accuracy. The SPLnFFT ($3.99) and SoundMeter+ ($1.99) apps both got excellent reviews here. Unless you have a high-quality Level 2 Sound Meter handy this is probably the best you can do. (You all know I’m not a sound engineer right?)

On A Personal Note

You probably don’t know (or don’t care) but I’m actually a reference in this peer-reviewed scientific study published by Pediatrics. No I’m not making that up – this study on white noise uses ME as a reference. Holy crap that’s bananapants right?
reference2

The downside about this reference is that it’s not entirely flattering. It suggests that I advocate the use of infant white noise machines (I don’t) and lumps me in with another blogger who advocates the use of white noise as loud as 85 dB (which is far louder than the 50 dB that I, and frankly modern science, suggests). Thus there is definitely a not so slight whiff of “crazy internet bloggers give bad advice” about it. Science News also links to me with the quote, ” And don’t be shy: The noise should be louder than you think.”

The suggestion is that I’ve been telling parents to blast their children with white noise. And sadly this couldn’t be farther from the truth.

There are many reasons I post infrequently (2 kids, life, I’m lazy) but one of the biggies is that I put a lot of time and research into my blog. If I’m giving advice I do everything possible to ensure that it’s backed up by credible science wherever possible and if there is ever a safety issue where there is no credible science to be found (baby swings anyone?) I’m always clear that it’s something you should discuss with your pediatrician.

And there’s a reason for this.

There is nothing more important than the safety of your child. Absolutely nothing. I get it. You get it. And never, at any moment, do I forget that fact.

My post on white noise (published April 2011 and unedited since that time) doesn’t recommend the use of baby white noise machines and is clear that the volume shouldn’t exceed 50 dB. That’s what I said 3 years ago and that’s what I say today. Everything I’ve written is in 100% accord with the white noise study. So I’m going to ignore the implied critique and focus on the upside – The American Academy of Pediatrics is writing about ME for a change. Yay?

But enough about me. Is anybody else freaked out about this? And if so, did I help or just make it worse?

The Ultimate Baby Food Allergies Survival Guide

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This article is AMAZING. And I can say that because I didn’t write it. It’s everything you need to know if you think your child might have an issue with something in their (or your) diet. How to figure it out, what the likely culprit is, and how to manage it. It’s fantastic and resource-rich. If it’s too long to read on a screen, skip to the end and download the full PDF for saving, sharing, or printing.
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Hello sleepy peeps! My name is Lori DeMauro I am a Mom to a beautiful one-year-old daughter named Annalise who has quite a few feeding issues, to put it mildly, with one of them being food allergies. It’s one of the things I was really unprepared for as a new mom and I fumbled my way through, making mistakes along the way, and driving myself crazy staying up late (in the few minutes the baby actually was sleeping) trying to find answers online. But if there’s a positive to all of this, it’s that I’ve learned a lot about food allergies. And hopefully  if I share what I’ve discovered it will save some of you the same frustration.

My daughter has an allergy or intolerance to each of the following: dairy, wheat, soy, eggs, and peanuts. She also may have celiac disease. The first symptoms of food allergies appeared when she was two weeks old, which is a really common time for symptoms to develop. At the time she was exclusively breastfed. She has had different reactions to different foods ranging from itchy red eyes to skin rashes to GI upset. This has made it very hard to determine what she was actually allergic to. I would research and take notes and think I had it all figured out and then eat something I thought was safe only to have her react. There are hidden ingredients everywhere. I have always been a health nut and habitual reader of food labels and I am a clinical researcher in my professional life so I thought I could take the knowledge I already had along with some quick research and be on my way.
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It wasn’t nearly that easy.
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With babies, you can never tell if a symptom is related to a food allergy or is just “normal baby stuff.” My daughter was born with several other health problems that compounded the issue with other symptoms. I could never tell which issue was causing which symptom or if they were all playing a role. In addition, being in the world we live in, there is actually too much information at our fingertips and I often found conflicting reports making. But there are some things we DO know.

Food Allergies in Babies

Food allergies occur in 5.1% of infants/children, up from 3.4% prior to 2011.  90% of all food allergies are related to what are known as the “Big-8”.That leaves 10% of food allergies related to “other things”, many parents report allergies to everything from corn to coconut.

The Big 8 Food Allergens

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  • Wheat
  • Soybeans
  • Fish
  • Shellfish
  • Eggs
  • Cow’s milk
  • Peanuts
  • Tree nuts

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While this list can seem a bit overwhelming (there is one or more of these ingredients in practically everything you enjoy eating) dairy (also known as Cow’s Milk Protein or CMP) is the most common with various studies suggesting that anywhere from 5-10% of infants having an allergic response.
Percentage of babies allergic to big 8 allergens

How do you know if your baby has food allergies/intolerances?

Determining if your child has a food allergy or intolerance is extremely difficult. Statistically we know that ~95% of babies have no issue with food so the default assumption should be that your baby does not have an issue. Also numerous studies show that parents self-diagnose their children as having food issues 4X as often as they actually do. So chances are that diaper rash is just a diaper rash, and not an indication of something amiss with diet. But some babies do have food issues and conclusively determining if they have an allergy and what they’re reacting to is challenging. So how do you figure it out?
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The best way to tell if your child is reacting to a food is to watch for symptoms.
[/pullquote]Testing isn’t reliable until at least one year of age and sometimes not even then.  Babies do not make enough IgE (short for Immunoglobulin E), the antibody that reacts to allergens, to result in positive testing.  If your child has a non IgE mediated allergy called Food Protein Induced Enterolcolitis Syndrome (FPIES), they would not test positive to an IgE skin test at any age. Often, physicians will suggest you wait anyway, as children outgrow many allergies by their first birthday and can continue to outgrow them throughout childhood.  Therefore, you watch, you experiment (with physician guidance) and you wait. (I will address a bit more on testing later.)

Also your child can have an allergy or intolerance. A true allergy means that the body has an immune symptom reaction, it responds to the food as harmful and creates antibodies to fight it. Symptoms can range from mild itchy skin to anaphylaxis. A food intolerance often has the same symptoms as an allergy, but is when a certain food irritates the digestive system or can’t be easily digested, so the symptoms are typically digestive (bloating, cramps, diarrhea).

Symptoms of food allergies/intolerances in infants can be confusing and hard to discern from other typical baby ailments. These include:
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  • Eczema
  • Diarrhea
  • Blood/mucous in stool
  • Constipation
  • Severe gas pain and/or stomach cramps
  • Body and facial rashes
  • Runny nose/congestion/cold like symptoms
  • Hoarse voice
  • Vomiting/Excessive Spit up
  • Itchy/watery/red eyes

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But wait, aren’t most of these symptoms common to all babies?  A hoarse voice and vomiting/spit up can be due to reflux, and most babies have eczema, lots of babies have constipation. So how do you know it’s a food allergy?

KEEP a FOOD/SYMPTOMS DIARY for you and/or your child (possibly both if you are nursing and your child is eating solid food). Be as detailed as possible, both in terms of what you/baby ate as well as any potential reaction. Make note of the time of day your baby ingested anything, whether its formula, breast milk, or solids.  Then record physical symptoms and behaviors.  Keep a diary for a couple of weeks and then look for trends.  Without the diary, you are also likely to forget what you or they ate, or what happened. In addition, it is something you can show your pediatrician if you suspect an issue. Be sure to read labels of foods you eat if nursing or on formula/solid food packages. There is hidden dairy, gluten, corn, and soy in practically everything!

Symptoms can range from subtle to severe.  Without the diary, you might overlook them or attribute them to general baby fussiness, that cold they got at daycare, teething, etc. The timing of reactions can be an indication of the type of response as well. Intolerances are going to reveal themselves over longer periods of time (via the gut) where a true allergy can cause a reaction within minutes to hours of ingesting a food (typically via skin, GI, and/or respiratory systems). Take vomit for example. If your child vomits and has swelling of the face quickly after eating a food, that indicates an IgE mediated allergy. If your child vomits severely and has diarrhea but not until several hours after ingesting a food, that indicates FPIES. FPIES vomiting can be so severe that it leads to dehydration or even shock. However if your child vomits a small amount hours to a day after ingesting a food and also has eczema or other GI symptoms, this indicates an intolerance.

Sample Food Log

sample food log

If, after consulting with your pediatrician and possibly a pediatric allergy specialist, you feel confident that your child has a potential food allergy or intolerance, you’ll need to start cutting those foods out of your child’s and if you’re nursing, your diet. Seems simple enough but in fact can be an enormous challenge. Allergens are hidden in just about everything you eat, infant formula, ready-made baby food, etc.

If you’re looking for practical advice on how to safely navigate food allergens (for both breastfed and formula fed babies) keep reading on the next page (click link below).

The Real Deal on Food Allergies

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We’re heading into the holidays AKA “that time of year where strangers will hand your children cookies and treats.” Why? Because seeing their little faces light up as they bite into a chocolate nut brownie is the absolute BEST. Or course you won’t be enjoying it because you’ll too busy exploding into a full-blown “OMG MY BABY JUST ATE THEIR FIRST PEANUT AND IS PROBABLY GOING TO DIE!” panic attack. Well luckily Dr. Benaroch is here to help sort the truth from the panic-inducing myths about food allergies. He’s an ACTUAL doctor (not just somebody who reads a lot and writes like she is…ahem) who blogs about why you need to get your kid vaccinated, sleep, and lots of other cool doctor-type stuff. Welcome Dr. Benaroch![/box]

Food allergies are real, and can make your child very sick. The idea that food can be dangerous is scary, especially when children start to go to school or share meals away from home. But sometimes concerns about food allergies go overboard.

But the truth is, food allergies are common, and becoming far more common. So it’s important to know what’s real about food allergies, and what is a persistent myth.

True allergies to food affect about 1 in 25 preschoolers. This has increased somewhat, probably by about 20%, over the last 10 years. However there are many children (and adults) who think they’re allergic, but really aren’t. And among people who do have allergy, the vast majority of reactions are mild.

If you have a reaction to a food, that means there is an allergy. “Allergy” refers to a specific kind of immune-mediated reaction. Symptoms of true allergy occur very soon after ingestion, and are consistent including: hives, difficulty breathing, vomiting, or diarrhea.

There are many other kinds of “adverse reactions” to foods that are not allergies. These include lactose intolerance, Celiac disease, heartburn, eczema, and many non-specific perceived changes in behavior. It’s important to make the distinction between a true allergy and other kinds of reactions because only true allergies have the possibility of leading to life-threatening reactions.

6 Common Food Allergy Myths

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  1. True allergies can be diagnosed by blood tests or skin tests.

    This is untrue. True allergy is a clinical diagnosis—you have to document the actual allergic reaction that occurs. Testing can sometimes be useful to confirm the diagnosis, but it doesn’t make the diagnosis. Even the best, state-of-the-art testing done by allergists can have false positive and false negative results. And the internet is rife with sites promoting quacky, weird tests that are even less accurate. Many people think they have allergies because of bad testing that has been misinterpreted. If your child can eat a food and doesn’t have an allergic reaction, he is not allergic—no matter what any “testing” shows.

  2. Any food can cause allergy.

    That’s theoretically true, but the vast majority of food allergies are triggered by one of “the big eight”: milk, egg, soy, peanut, tree nut, fish, shellfish, and wheat. Extensive testing beyond these foods, without a history of a suggestive reaction to a specific food, is much more likely to falsely label an allergy than to uncover a true problem.

  3. Any child with allergy can have a life-threatening reaction.

    Most people with allergy have the same reaction with every ingestion—if they had hives last time, they’ll probably get hives again. However, it is possible for even mild reactions to be followed by more-serious ones, so parents and school do have to be alert.

    A history of asthma or recurrent wheezing is an important risk factor for life-threatening food reactions among allergic individuals—even if wheezing or asthma hasn’t been triggered by foods in the past, anyone who has both a true food allergy and a history of asthma is at higher risk of a very serious reaction. Additional risk factors include a history of a prior life-threatening reaction to anything, or an allergy to peanut, tree nut, egg, fish, or shellfish.

  4. Life-threatening reactions can occur through air or skin contact.

    Peanut allergy alone accounts for about 80% of the deaths from food allergy in the United States, causing about 160 fatalities a year. For comparison, lighting strikes each year kill about 50-100 people.

    Although it’s theoretically possible, all documented serious reactions have occurred from eating the food. “Peanut dust” in the air or touching peanut-contaminated surfaces has caused skin and eye and nose symptoms only. The best way to protect allergic kids is to prevent ingestion. Don’t allow sharing of foods, utensils, drinks, or cups, and wipe down eating surfaces to prevent cross contamination. Foods in the environment don’t cause serious reactions unless they contaminate other foods and get eaten.

  5. Food allergies are permanent.

    Most kids with egg, milk, and many other allergies will usually outgrow them. However, allergies to peanut, treenut, fish, and shellfish may have only about a 20% chance of resolving. Recent research into egg allergy specifically has shown that small, limited exposures to egg (typically, baked into food) can make it more likely that a child with true egg allergy will outgrow it.

  6. Avoiding foods early in life helps prevent allergy.

    This is a persistent, lasting myth that is completely untrue. In fact, delayed introduction of foods increases the risk of allergy. Pregnant and nursing moms should not avoid any foods, unless they themselves are allergic.

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What if My Child Actually Has a Food Allergy?

Food allergies can lead to severe or life-threatening problems, though these kinds of reactions are rare. If you suspect your child has a food allergy, work with your pediatrician or a board-certified allergist to clarify what’s going on, and develop a plan. You’ll need instructions on how to avoid the trigger(s), and an action plan for what to do if an ingestion occurs. Make sure to share these instructions with the school and all caregivers, and make sure there is always access to the emergency medications that have been prescribed. With knowledge and reasonable precautions, food allergies can be managed, and parents do not need to live in fear.

Food allergies: Myths and facts
© 2012 Roy Benaroch, MD
@PedInsider
PediatricInsider.com

PS. Because it was JUST on SNL this weekend I thought I would also include this funny digital short about faking allergies to get out of stuff you don’t like. Cheers!-Alexis

The Sleep Scandal of 2012

“Here’s what a child’s bedtime looks like to couples expecting their first baby: the nursery is softly lit, the child is sweetly sleepy, the last page of Good night Moon has been read. After that comes the final tuck-in, the gentle kiss, and finally, the quiet tiptoe out of the room.

So how often does this happen after the kids arrive? The answer – rounding to the closest zero – is zero.”

This is the opening paragraph to the article Please, Please Go to Sleep in the March 28th edition of Time. The article goes on to discuss the hubub about a February article published in Pediatrics called Never Enough Sleep: A Brief History of Sleep Recommendations for Children which was talked about just about everywhere else.

I’m sure you’ve all been following the Sleep Recommendation Scandal of 2012 as closely as I have right? Right? Hello? Well just in case you’ve been too busy standing in line for Hunger Games tickets, here’s a brief recap.
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  • The Pediatrics study analyized historical data about recommendations for sleep vs. ACTUAL sleep and determined that recommended sleep has been decreasing just under 1 minute a year since 1897, and that actual sleep has consistently trailed recommended sleep by ~37 minutes.
  • The study included this not-at-all-inflammatory-to-pediatric-sleep-specialists line: A lack of empirical evidence for sleep recommendations was universally acknowledged.
  • The world of pediatric sleep specialists pooped themselves about it.
  • OK I can’t actually confirm the pooping part but they collectively vomited all over the article en masse. This included one rebuttal co-signed by just about every published pediatric sleep researcher on the planet. And Mars.

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One interpretation of the study is that sleep specialists have been pulling sleep targets out of their butts for as long as sleep specialists have existed. And that never, at any point in time, has any parent managed to achieve the level of required sleep for their children. Thus your child’s sleep is a distant windmill and you can tilt at it till your hands bleed but you’re never going to conquer it.

I’m no doctor but I’m also pretty chuffed about this study. Nobody is standing up to defend the 1897 study that suggested your 2 year old should sleep 16 hours a night (although it would be AWESOME if that were true) because Victorian doctors thought so many bizarre things, why single out just one?

But the implication that pediatric sleep specialists (who, to be clear, are DOCTORS who SPECIALIZE in KIDS and SLEEP) have no basis for their recommendations is frustrating. And hinting that recommendations about sleep are bogus and unattainable just gives people room to convince themselves they don’t have a problem.

And that’s a problem.

I often have people tell me, “My kid just doesn’t need that much sleep.” Translation: their kid is barely sleeping. If you press the “my kid doesn’t need that much sleep” people you’ll almost always get regaled with stories of babies who stopped napping at 1, who refuse to go to bed till 11:00 pm and are up with the sun. But it’s OK because that’s “just how their body works.”

Is it really OK? There are two possible truths here.
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  1. It’s true.

    Yay! I am fully meeting my child’s needs and have nothing at all to worry about. Woo hoo!

  2. It’s not true.

    My child is suffering from chronic sleep deprivation and this is a pretty serious issue that impacts their behavior, ability to learn, process sugar, grow, and manage their emotions. This is a problem we need to take seriously and it’s probably not going to be easy to fix.

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If I were that parent I guess I know which option I would want to cling to. And I would probably be keen to find a piece of research which suggested it was true. Even if it wasn’t.

I understand why it is a huge challenge to develop a scientific study that determines conclusively how much a child or adult really needs to sleep. And I know that there will always be a great degree of variability in the results (some of us are short/long sleepers). And perhaps I need to accept that we don’t really know how much sleep our children need. But I do know they need a lot. Here are some other things I know.
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  • 50% of parents of infants and 27% of parents of school aged kids feel their child doesn’t get enough sleep (source: 2004 Sleep Foundation Study)
  • American children get less sleep then kids in almost all other countries. (source: Time article, Sleep Duration in Young Adults)
  • Even small decreases in sleep can have dramatic impact on your child’s ability to function. (source: Lost Hour of Sleep)
  • Chronic sleep deprivation has been linked to childhood obesity. (source: Meta Analyis Short Sleep Duration and Obesity)

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There will be a lot of families with chronically sleep deprived kids who will see this study as evidence that they have nothing to worry about. And that’s unfortunate.

I hope that the Sleep Scandal of 2012 results in further funding on kids and sleep so that we can come up with more conclusive research about how sleep impacts our bodies, how much we need, and how critical it is for our children to be happy, healthy, emotionally stable kids. Because there shouldn’t be any debate about that.

Hello Teeth Goodbye Sleep!

Sometime between 4 months and 2 years of age your baby will get 20 new teeth. So if the eruption of each new tooth causes you 3-5 sleepless nights, then you can expect to have about 100 bad nights due to teething.

Wahoo!

Actually compared to other baby sleep stumbling blocks, teething is relatively benign because:
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  • Not all teeth will cause problems (some you won’t even notice until they’re already in).
  • Some teeth will come in simultaneously.
  • Unlike sleep regressions, you can actually do something about teething.

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Teething rarely causes any serious problems. There are plenty of resources on how to care for your teething baby and everybody generally figures out which trick of the trade (frozen wash cloth, rubber nubby, gel-filled teether) works best for their baby. Anything you and your baby choose is probably great if it works for you and it doesn’t contain benzocaine (no Anbesol or Orajel even if the label says OK for babies).

But here’s thing about teething and sleeping, none of your frozen bagels or colorful rubber rings work when your baby is asleep.

Help Teething Babies Sleep

I get lots of questions about teething babies. And to these questions I have only one answer.
PAIN RELIEVER.

Tylenol or Motrin are your not-so-secret sleep aids. Why? Because they’re the only things that will sooth sore gums while your baby sleeps.

Depending on which medicine you prefer your average baby dose will cover anywhere from 4-8 hours of teething pain. Which means if your baby sleeps 10-12 hours a night one dose won’t get them through the night.

Giving Medicine at Night

You want to give your baby their first night dose at the most logical time based on the doseage of whatever (Tylenol, Motrin, et al) you are working with. For example if your pain reliever works on a 6-hour dose and your baby wakes to nurse at midnight then you’ll want to give them their medicine at 6:00 PM so that you can give them a second dose during the midnight feeding. This would presumably cover them until 6:00 AM which should be close enough to their normal wakeup to work.

time your teething pain relieversIf your baby doesn’t wake up for feedings at night (YAY for you!) but IS waking up because of teething discomfort then they still need a night dose of pain reliever. You can wait until they wake up unhappy however I don’t recommend you do so. Why? Because now you have a fully awake and unhappy baby who will need to wait for ~30 minutes for their pain reliever to kick in.

Ideally you would give them their second dose BEFORE they wake up. Let’s say you gave them a 6-hour dose at 6:00 PM. And they are generally waking up unhappy at 2:00 AM. I would recommend giving them a proactive dose at midnight (which is when they are “due” for more anyway) while they are still largely asleep.

While your baby is still asleep gently put a syringe or bottle dropper of pain reliever into the back corner of their mouth. Very gradually put the medicine in their mouth (not too fast, they’re asleep after all!). Most babies will just quietly swallow the medicine without waking up. Play around with a technique that works for you but preemptive medicine can really soothe over rough teething spells. For even the most painful tooth eruptions you’ll probably only have to do this for 2-3 nights.

When Nothing Works

If no amount of Tylenol and frozen teethers are helping your baby talk to your pediatrician about temporarily increasing the dosage. Generally the dosage for infant pain relievers is very conservative (read: low) and it might be time to give it a little boost.

Anybody else have any teething tips to share?