This article is for the baby who has acquired these skills but needs a little convincing before he can make it 11 hours.   There are many different strategies to coax your baby to use their skills and sleep through the night.  Each strategy shares one common theme – consistency.   The key is to choose the strategy that speaks to you and do it consistently for two weeks.   

One of my favorite techniques is the sleep wave from the book The Happy Sleeper.   This method employs a very short scripted visit from a parent every 5 minutes after a baby has begun to cry.  It is important to keep the script short (“I love you and I know you can do this”) and recite it each time you enter the room.  It is also important to leave immediately after you say your scripted words.   Each visit should take about 10 seconds.  Initially, your baby will  become frustrated when he realizes that you are not bringing the goods.  Over a few nights, he will begin to recognize your behavioral pattern.  The predictable nature of these 5 minute visits reassures and comforts the baby and allows him to fall back asleep.   

This is an excellent tool during the 9 month sleep regression.  At 9 months, babies have developed object permanence and separation anxiety.  Even the best sleeper awakens every couple of hours when he realizes his parents are not there. The sleep wave provides an excellent vehicle to reassure him that you are present while still giving him space to settle himself to sleep.  

• How do I keep my children moving in our small apartment?

• How do I maintain a level of physical activity for them?

• What activities should they be doing for their age?

• How can we encourage burning all that excess energy when we are so restricted?

I’ve been a physical therapist for over 20 years, mostly working with the pediatric population in New York City.  As I reflect on the current situation and my experience, I want to share some ideas and share some activities that can be done in a small space and encourage the development of age-appropriate gross motor skills.  In other words, let’s go over some games to keep our infants and toddlers moving.

First things first…What are gross motor movements?

They are movements involving the large muscles of the body such as arms, legs, and torso, that help us do things like crawl, walk, jump, kick, sit, throw, lift, and catch.  Gross motor skills are important because they allow us to explore and interact with our environment. Through movement we build confidence, cognition, social awareness, speech, fine motor skills, and overall health.  Pretty important, right?

Gross motor skills for infants (2 months to 1 year) include:

Rolling, laying on the belly (prone positioning), quadruped (on all fours) creeping, crawling, tall kneeling, sitting, pulling up to stand, and cruising.   The activities that can be done to encourage these moments are limitless and can be fun. They requiring very little space and a few toys or props:

• Ring sitting or side sitting and working on stacking, turning pages, clapping, and playing peekaboo.

• Crawling to reach a toy and reaching for objects

• Crawling through a tunnel or over a cushion or even over your leg.

• Cruising along furniture to reach a stuffed animal.

Gross motor skills for toddlers (1 year to 3 years) include:

Toddlers are working on the ability to stand, walk independently and ultimately climb the furniture.  Older toddlers begin to kick, catch, jump, and run. Activities to help toddlers develop these skills  may require a bit more space but can still be done in a New York sized apartment.

• Some aides that can facilitate these activities are music, balloons, hula-hoops, streamers, masking tape, pillows, shaving cream, bubbles, and cotton balls, even feathers.

• Making an obstacle course is a great way to engage a toddler to move. For example, you could challenge your toddler to walk on cushions or jump over a broomstick.

• Balloons are also great for encouraging movement.  You can create games with balloons such as hockey or volleyball.

• You can make a maze with streamers  where your toddler will have to walk over or under certain obstacles.  You can also make shapes on the floor with masking tape and work on jumping.

You can encourage all of these movements by offering them the opportunity to practice. Plan a time to do physical activities daily and you really don’t need that much space. As you can see the possibilities are endless. Be creative, make them challenging, offer encouragement, and most importantly keep them moving!

Pregnancy and postpartum are special yet challenging times for new mothers. They have just experienced a major event – physically, mentally, and emotionally, after which they must build a new normal. A new mother often yearns to return to her pre-pregnancy routines in order to regain a sense of structure amid the daily changes that come with a newborn.

Exercise can be one activity that a postpartum woman anticipates returning to fully. But what does exercise mean versus what should it mean? Most doctors give clearance approximately 6-8 weeks after delivery; however women should not expect to dive right back into their old routine as there is a risk of injury along with some psychological elements.

During postpartum, new moms can experience endorphin boosts which signal the brain that you can “take on the world”. Coupled with a new body, moms often get back to their usual exercises right after receiving the green light. The brain is ready to workout because you cannot see all of the healing that needs to happen internally (ie – everyone’s favorite topic: the pelvic floor).

For example, if a new mom was an avid runner prior to pregnancy (and even during first and second trimester) and she receives clearance to exercise, she will most likely hit the ground running (no pun intended). But what happens when she feels pressure in her pelvis, low back pain, ankle instability, or a combination of the three? Unfortunately, this is a very common occurrence and can result in a myriad of issues. After ten months of creating and carrying a life, the postpartum body needs the proper time to heal.

After giving birth to my son in 2016, Pilates was the best regimen for what my body had been through. By focusing on breathe, core strength, alignment, mobility, posture and pelvic stability, Pilates can help with many physical and emotional issues that postpartum women experience:

Diastasis Recti 

During pregnancy, the muscles of your abdominals stretch to make room for the growing baby. Once the baby is out, the muscles are overstretched, which can cause diastasis recti, a thinning of the linea alba and separation of the rectus abdominis from the linea alba. Most women will have some form of diastasis recti during and after their pregnancy, regardless of how fit/active they were. Pilates helps to strengthen the deepest abdominal muscles, known as the transversus abdominus, to help restore the core’s functionality. By finding proper engagement in the core, new moms can begin transitioning into exercise safely (think planks and mountain climbers).

If you are unsure whether you have diastasis, a Pilates instructor certified in pre- and postnatal rehabilitation or a Pelvic Floor Physical Therapist will be able to conduct an assessment and work with you to build strength and structure back safely.

Pelvic Floor

During pregnancy and after childbirth, women might notice some discomfort surrounding their pelvis. Some moms will say they feel as if the baby is “about to fall out” while others experience urinary incontinence. Both cases are caused by pelvic floor dysfunction, whether it be weak or overactive. Pilates helps to connect a woman’s breath pattern to her pelvic floor, improving the overall pressure system and restoring functionality. Finding the breath connection helps to strengthen and/or release where needed. Surprisingly to most, the pelvic floor is an anticipatory muscle and by learning proper activation, will function normally on its own again. Taking the time for this early on after delivery will help decrease recovery time.

Stress

As we all know, new moms are fatigued and sleep deprived, focusing their time and energy on their new baby. But it’s important for new moms to take time for themselves. By using the breath work and restorative movements of Pilates, moms can reduce stress, calm the nervous system, increase endorphins and reconnect to their bodies. Furthermore, although it has not been clinically said, there are many studies that show a reduction in postpartum depression in moms who incorporate Pilates into their lives.

A woman’s body changes greatly during pregnancy. After birth, many new mothers are rediscovering their bodies and should ease back into fitness mindfully. Pilates is the perfect path to guide them on the journey to regaining strength and improving body mechanics. By restoring proper functionality to a new mother’s body, she can feel healthy, energized and ready for the new adventure ahead.

We’re all in the same lifeboat.   We have to depend on each other; it’s not a choice.  Some families that struggled in peaceful times might thrive in this crisis.  There are good reasons for that.  Appreciate it and go for it.  Any unfinished business, old hurts, political differences, wish to control each other, all of those truly have to wait. Everyone’s egos have to rest as long as this lasts.   Not every partner gets it yet and hopefully they will soon.  Try.to remember we are all in the same lifeboat.  Do your best to cooperate.  Do your best to stick to best health practices and care for all members of the family for the next few months.

Maybe your family has decided to shelter children in one home.  If so kids must stay in close touch with their other parent; it’s not a choice.  If a parent and child don’t see each other for 2 or 3 more months that’s very stressful.  Using screen devices to stay in touch will help the whole family. Please be encouraging, respectful and generous about communication time.  Our family has allowed screen devices at meals for the duration of the crisis, to stay in closer touch w family.  Since the crisis our whole family has sat together at meals as much as since splitting in to two homes.  The parent out of the home could come over often for walks together and/or picnic time outside.  When outside, keep distance, wear masks and make careful choices is essential and also tough to control.  Your family may decide to balance ideal physical safety with the emotional safety and comfort those visits.  Consider shared experiences by viewing tv shows and movies together, facetiming during school, play and homework, a family journal.

Every parent that encourages a good relationship with the other parent gets a parent win for their child and the whole family.

Maybe your family has decided to continue traveling between homes.  That’s what we chose.  It’s a necessary choice to balance pure physical safety with normalcy and family routine.  Some basic expectations have to apply. Everyone has to wash hands constantly, cover faces out of the house, keep 6 foot distance (extend an adult’s arms. “this far” That’s around 6 feet).  Stoics and naysayers are wrong, no debate. This is deadly real.  Screen devices might be used a bit more to keep both parents and child in touch in this worrisome time.  More comfort from both parents is always a win.  Together or apart, your family should agree on their plan for what to do if one parent gets sick.  A go kit keys, chargers, passwords, papers or necessary information should be at hand.  It could be a good choice to agree that if someone falls ill, the other parent is the back up as long as they’re well.  They see that the sick home is fed and called on the phone, has clothing, medicine and frequent check ins.  They’re probably the one who would get the ill parent and child to the ER if necessary.

We are in a figurative lifeboat together.  We have a chance to chose how we will be, how we will act in a time of crisis.  The emotional and physical consequences of how we act are very serious.  We should strive to be the people we would admire in a crisis.  If we survive this physically but deeply emotional wound each other at the same time we will regret it.

Me and mine offer you and yours our deepest hopes that you stay well if you’re well, heal if you’re ill, and find comfort if you’re grieving now and after this.

The world as we once knew has drastically changed. Quarantine has become our new norm. However, this is new and extremely challenging. How can we survive being cooped up at home endlessly with ourselves and family? Based on my experience and observations, the success of our survival will be dependent on several major concepts; positive perspective, staying calm, reprioritizing, exercising flexibility and most importantly, teamwork

➔ Positive Perspective-
The first thing you need to know is that this situation is temporary. Although we don’t know when this quarantine period will end, it can’t go on forever. So be hopeful. It will run its course, and this too shall pass! Everything in life is all about our perspective. In every negative situation we must look for something positive to help us deal with the uncontrollable event. How we go about finding the positive from negative is personal and up to you to make the situation work best for you. Sometimes the positive is a learning experience or helping us shift more important things into perspective. The key is find something good within the awful to feel somewhat in control and help us effectively cope.

➔ Feeling calm
The next thing is to take as many deep breaths as you need. The most effective way to weather a storm is by being prepared and being calm will be your best tool to help you deal with being quarantined. When you are calm you can think clearly, focus better, and be present. And remember, it’s all about perspective. Quarantine is happening regardless if it works for you or not. You need to find a way to make quarantine work for you so you can calmly survive.

A:Stop the Yelling by Identifying the Sources of Stress
When you are calm you don’t feel the need to yell. Ask yourself, What compels you to yell? Are you nervous? When you are Nervous you end up yelling more instead of talking. Make a list of few triggers that cause you to yell. Identifying the source is the first step to problem solving.

B:Being Intune to your feelings
What is making you feel uncalm? Journal writing is helpful in identifying feelings and triggers and a great tool to use to express yourself, release tension and relieve your mind of stressful thoughts. You can then share your thoughts with those who need to hear how you feel or you can close the notebook feeling emotionally lighter (having just vented in safe space) and continue about your day. Not every situation has a chance to get resolved but letting your thoughts out in a safe space is cathartic and can allow you to move forward even if change hasn’t yet occurred .

C: Being Present
Do you find yourself constantly being disrupted by family members? Being forced to lose your focus can be very frustrating, making you lose your cool and causing you to yell out displacing your frustrating feelings onto your child or spouse who maybe just wanted to ask you a simple question. Try being present and not so focused on tasks that can wait so you’re readily available for your family’s needs.

That leads me to my next point…

➔ Reprioritize –
Life as you once knew it is now completely different. Whatever structure you had in place before, now may no longer be useful. You need to reprioritize and shift your focus to what’s most important now, during quarantine times.

A: Shifting focus
I have metnally compartmentalized my day where in the morning my focus is only on ‘online schooling and caring for my kids’. Everything else, like house work etc. are secondary in my day and I focus on them only after online school has ended. Shifting my focus to what I find most important now has allowed me to naturally feel calmer because although I’m still multitasking by facilitating 4 online classes simultaneously I am only focusing on school and not the many other things I also need to do.

B: Slow Down
Life has slowed down tremendously and we too need to slow down with it. The concept of running around, places to go, people to see, and countless errands to run, at this time have mostly become nonexistent. Therefore, we need to stop running the halls of our house, take a deep breath and slow down. The outside world has shut down. Most important things now can wait. So live in the moment with your family at home. Think of quarantine as a long vacation of not taking care of all of your previous responsibilities and fill that time with quality family time.

C: Unnecessary Stress
Don’t add on any extra work on your plate that will cause unnecessary stress. Think about what “to do” things you can skip or push off for now. Your plate is already full with the kids being home all day, being responsible for in-homeschooling, working from home and not having your usual outlets available to support you since the world outside is under quarantine.

And lastly,

➔ Flexibility –
Scheduling and structure are usually key to running an organized household. During quarantine times, those rules have changed. In order to survive being stuck at home, I find that you need to be more flexible with your daily schedule, with screen time and all activities, in general since life, at the moment, is not being lived as normal. You’re still the parent of your home. Do as you see fit. Create a flexible schedule or just go with the flow. The key now is surviving quarantine in the calmest most effective manner, in whatever way that works for you and your family. Allow your family to partake in the schedule planning or in selecting which activity they’d like to engage in. You no longer need to do things alone. The family is all together. Make it a team effort. Teamwork will be another major key to your survival.

Although quarantine can affect everyone differently, we are all experiencing the same thing simultaneously. We need to find a way to stick together and be there for one another. You are not alone. So find a positive outlook on quratnined life. Try your best to remain calm. Be more present and focus only on what’s most important and remember family is definitely one of them. Practice being flexible and exercise teamwork. Now is the time to utilize you and your family’s strengths to be unified and work as a team. We are all in this together.

Henny Reiser, LCSW
Quarantine 2020

Short Bio:
Henny Reiser LCSW is a psychotherapist in private practice working exclusively through teletherapy and helping others dealing with grief, depression, anxiety, marital conflict, parenting skills and behavioral problems.

Contact info:

HennyReiserLCSW@gmail.com
Instagram @HennyReiserLCSW
FB Henny Reiser LCSW
https://www.linkedin.com/in/henny-reiser-57a38553

I like to break sleep development into two stages.  The first stage begins at birth and extends through 4 to 5 months.  This is the period where you are teaching your child the skills that he or she will need to be a self-reliant sleeper.  Your goal during this time is to teach your child to fall asleep and to fall back asleep independently. 

During the second stage, you challenge your child to apply the skills that he/she has learned.  This is the time when you no longer intervene. You trust that you have taught your child and he/she will apply this new skill set and make you proud.  

The 1, 2 ,3, 4s of creating a good sleeper 

Month 1

One – Around 4 to 5 weeks, infants start to develop circadian rhythms.  In order to get yourself and your baby to function on a daily cycle, try to respect this developing rhythm.  You can do this by feeding during the daytime (7 am to 7 pm) in a bright area and engage your baby as you feed. In contrast, keep your nighttime feeds (7 pm to 7 am) in a dimly lit room and keep them quiet.  

Month 2 

One – Around 8 weeks, start to develop a consistent bedtime routine that begins with the breast or bottle feed, includes baby massage, and ends with your baby entering the sleep environment awake but drowsy.   

Two – Respect the fact that your baby needs a lot of sleep during the day.  Between 2 and 6 months, plan to place your baby back down to nap after being awake for no more than 90 minutes.  This will help you to have a content baby during the day. It will also help you with evening sleep. If you respect the need for sleep during the day, you will have an appropriately tired baby at night.  If you don’t, you will have a fatigued and fussy baby at night.

Month 3    

One – Around 12 weeks, you should notice that your baby’s bedtime has drifted from about 9 pm to around 7 pm.  At this point, you want to prioritize a consistent bedtime. Start your bedtime routine about 30 minutes before you anticipate bedtime.   

Two – Try to provide your baby with independent play time during the day.  Give your baby a few minutes to play alone before you engage him/her. You want your baby to be comfortable with independence.   

Three – Between 2 and 4 months, your baby should sleep 6-8 hours overnight.  If you feel that your baby might be capable of doing this, when your baby stirs, climb a slower more deliberate sleep ladder (a strategy from the book “The Healthy Sleeper” that we will discuss during the IG live session) and see if your little one won’t take the initiative and go down with minimal or no help.    

Month 4

One – Make sure your baby is sleeping in his or her own sleep environment.  This is the age babies start to appreciate their sleep environment. Whether it is napping or sleeping at night, you want to put your child to bed in a familiar setting.  This will make your baby more comfortable falling asleep and it will help him/her to fall back asleep when he/she awakens overnight.  

Two – Around 4 months, you will see children start to consolidate their daytime sleep and develop a 3 nap daily schedule.  Let your child take the lead but anticipate this.  

Three – Most people have heard of the four month sleep regression.  As a parent, your confidence might be shaken as your strategy seems to be faltering.  Double down on your strategy and remain extremely consistent. This regression is a moment of neurological development where babies are hyper-alert and active.   If you overreact, it will undo the work you have done to this point. You should stick to the sleep ladder and realize that this phase will pass.   

Four – Some time between four and six months, your baby will most likely mature and become capable of independent sleep.  Your baby will consolidate sleep and spend 11 hours overnight without requiring a feed or some external soothing. When you feel that it is time to make this transition, commit to a 1 to 2 week period and consistently employ a strategy that suits your family.  I often recommend a sleep wave (a second strategy from the book “The Healthy Sleeper” that we will discuss during the IG live session) but you need to find the strategy that fits your situation.  Whether it is a wave, a fade, or an extinction model, consistency is secret to success.   

One last word on consistency.  I always emphasize consistency with flexibility.  It is always important to remember that parenting is a dialogue. You always need to remain present to what your child is feeling or when a situation may have changed.  This is never more important than with sleep. If you had an unexpected event in your family or you or your partner are not capable of following through on your plan, re-assess the plan and start again.    

This post is meant to be an introduction for our IG live tomorrow. We will elaborate on a number of these topics tomorrow.  If you are not able to attend or have other questions, always feel free to reach out and we can discuss this in a bit more depth. 

Got a Plan? Prep for Postpartum Success

Most pregnant parents are understandably focused on when and how their baby will enter the world. This day of birth emphasis is entirely understandable, given the 40 week countdown, the budding belly and the thoughts of how-the-heck-am-I-going-to-get-this-baby-out!?

However, many parents gloss over what comes following the birth, which I would argue is actually more critical. Afterall, the birthing process lasts 24 hours, give or take. Your child will be with you for many (18?) years. So let’s look at some practical tips to make that initial transition from pregnancy to new parenthood a success.

• Postpartum care: You likely have a healthcare provider now but have you looked into care following the birth? Checking out postpartum doulas and baby nurses may well be worth the effort. (Do you know the difference between the two? Baby nurses are often not actually nurses, but have experience caring for newborns. They focus exclusively on the baby’s needs. Postpartum doulas take care of the family and some provide breastfeeding support.  They often tend to light house cleaning, cooking, errands and demonstrate baby care to parents.) These providers can often book up weeks or months in advance, so it’s wise to interview and line up someone in ahead of time. How do you find these folks? Most neighborhoods in NYC have local parent listservs on groups.io, Google groups and/or Facebook. Hearing from neighborhood parents about resources can give you a place to start your research and help vet candidates.

• Breastfeeding support: If you are planning to breastfeed, know that you might need some help. Your local La Leche League (www.lllli.org) can be a fantastic source of information and guidance. Meetings are free and run by volunteers. Ask around about lactation support to create a list of people you can call on in case you hit a snag nursing. There are various levels of certification, and someone with an IBCLC has much more training than someone with an LC or CLC. Services like boober offer on-demand lactation help and are worth checking into as well.  Having contact ahead of time with someone you feel comfortable with is wise. You may not need to call on them, but knowing that you vetted someone in advance and can reach out if the need arises, can really bring down anxiety levels. Premier Pediatrics has established a breastfeeding program as a part of The First Month that integrates breastfeeding support into their well care. They include visits in specially equipped feeding rooms at a fraction of the cost for a lactation consultation.

• Baby’s healthcare provider: You will be expected to bring your baby to a first pediatrican’s visit within a few days of the birth. Lining up a provider who shares your philosophy about treating illness, vaccination schedules, and use of medications is key.  Most doctors are happy to arrange a prenatal interview to answer your questions. I recommend finding someone with a convenient office location and hours, as schlepping across town with a sick baby is not fun for anyone!

• Personal support: The transition to parenthood can be wonderful, scary, intimidating, exhilarating, and challenging–sometimes all at once.  Finding someone with whom you can unpack these mixed up feelings can be a real help. It takes strength to recognize and act when you need extra support. No one was meant to walk this path alone. Oftentimes, parents are far from their own families of origin and don’t have that built in support network. Sometimes people are the first in their cohort of friends to become parents, which can be lonely and isolating.  Folks that don’t have kids may not understand what it’s like to face the challenge of parenting here in New York City. Finding a therapist that specializes in helping during pregnancy and beyond can be a huge help. There is no need to suffer with excessive worry, anxiety or depression. Taking care of yourself allows you to best care for your baby.

NOTE: If you are more worried than seems normal, feel more irritable than usual and/or can’t find the joy in your day to day, reach out for help. Postpartum Depression and Anxiety –which often starts in pregnancy– is THE most common postpartum ailment, is very treatable, AND is not your fault.

All sleep strategies are based on the idea that parents can create a consistent environment so that their infant can learn a new skill set in a predictable and comfortable environment.  The ability to carry out a consistent strategy for one to two weeks is perhaps more important than the strategy itself. Yet, it is easy to focus on consistency so much that you stop listening to what your baby is trying to tell you.  You always want to remain curious and be willing to adjust your strategy as your baby’s needs change.

We are looking forward to the “Raising a Happy Eater” on March 13.   We hope to see you there!

There are emergencies that require travel before 2 months and, if this is the case, I think it is ok to go.  You should check with the airline to see if they have an age minimum. 

Regardless of when you travel, always make sure you are the first folks on the plane and the last folks off the plane.  The aisles can get pretty chaotic when everyone is getting on and off. Also, I recommend researching a health care facility at your destination just in case.  Remember, your pediatrician is available 24/7 by phone no matter where you are. So, if the need arises, I recommend calling your pediatrician as your first step.