Simple Ways to Calm a Crying Baby
And Have a More Peaceful Night’s Sleep
本文刊載於United States Lactation Consultant Association〔USLCA, 美國授乳顧問協會〕的官方期刊Clinical Lactation《臨床授乳學》網頁，編號Volume 4 Issue 2，Issue 2探討睡眠訓練及相關議題。
作者：Sarah Ockwell-Smith, John Hoffman, Darcia Narvaez, Ph.D., Wendy Middlemiss, Ph.D., CFLE, Helen Stevens, James McKenna, Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, Tracy Cassels
“My baby is only happy in my arms. The minute I put her down she cries.”
“She wakes every hour throughout the night, every night. I’m exhausted.”
Common Statements from New Parents
Most infants wake at night and expect comfort from their parents.
The number of times infants wake and need help to return to sleep decreases as they grow but still remains fairly common. Re-cent research by Weinraub and her col-leagues confirms how normal it is for babies to wake at night, with 66% of 6-month-olds still waking at least once or twice a week and the remaining babies waking even more of-ten. Some babies will cry when waking at 12 months of age—even babies who have set-tled back to sleep on other nights.
Helping an infant return to sleep easily, then, is an essential gift to give our infants, and an important goal for parents who need to rest. The science of nighttime care pro-vides a good foundation for parents trying to calm their babies. It clarifies what is im-portant to know about calming babies and why certain types of calming are most likely to be helpful.
What Is Important to Know about Calming
A parent’s presence helps to calm babies who awaken in an upset state.
Babies (especially in the first few months) are not yet capable of regu-lating their emotional states. This is one of the reasons why crying tends to increase in the first two to three months of life and then de-crease steadily after that. Infants cry or fuss for many reasons, includ-ing hunger, pain or other discomforts or, at times, simply a desire for physical contact. For example, carrying infants from three to four hours a day reduces the duration of infant crying/fussing behavior generally by as much as 43% at six weeks of age (Hunziker & Barr, 1988).
寶寶(特別是剛出生幾個月的)還不能控制他們的情緒狀態。這是為何哭泣會在前2~3個月增加然後穩定減少的原因之一。寶寶哭或鬧有很多原因，包含饑餓，痛或其他不適，或者有時候只是想要身體上的接觸。例如，每天背著6週大的寶寶3~4小時，可以減少43%的哭鬧行為時間(Hunziker & Barr, 1988)。
Fussing and crying are the most important means by which an infant communicates needs and desires. The specific reason can-not always be determined, but for sure, displaying visible and audible signs of distress is an infant’s most important defense and is overwhelmingly adaptive. When upset, babies depend on sensory input from caregivers—touch, soothing voice, smell, eye gaze, breastfeeding—in order to calm down. That’s the way na-ture designed it to work.
Babies rely on their caregivers to calm them and to help deal with other reasons they are unhappy or uncomfortable, such as being in pain, hungry, or in some sort of physical or emotional state that we can’t determine. Being present and attending to infants when they wake and cry can help infants return to sleep more quickly (Mao, Burnham, Goodlin-Jones, Gaylor, & Anders, 2004).
寶寶依賴照護者的安撫來幫助應對讓他們不開心或不舒服的原因，例如覺得痛、餓、或身體上或心理上的不確定因素。當寶寶醒來時現身幫助他可讓寶寶較快再次入睡。 (Mao, Burnham, Goodlin-Jones, Gaylor, & Anders, 2004)
Calming infants helps infants learn to calm them-selves.
By helping infants calm down by attending to their distress, caregivers help infants develop the tools—both physiologically and emotional-ly—to calm themselves. This is what parents help children with generally (Davidov & Grusec, 2006; Stifter & Spinrad, 2002). Parents are of-ten hesitant to be present when babies cry, fear-ing that attending to crying babies will lead ba-bies to be unable to deal with distress on their own. But this approach only leads to a fussy ba-by and a clingy child.
藉由現身幫助嬰兒平靜，照護者幫助嬰兒發展一些工具－包含生理上及心理上－來使自己平靜。這是父母幫助孩子的普遍方式。(Davidov & Grusec, 2006; Stifter & Spinrad, 2002) 父母若是因為擔心去幫助哭泣寶寶會讓他不能自行處理悲傷，而遲疑不現身幫助，反而只會導致寶寶更愛哭鬧及更黏人。
Leaving babies to cry increases babies’ stress levels and often keeps them awake longer. It does not guide them emotionally or physically toward the goal of regulating their own distress and response. Instead, to develop “good” or “healthy” sleep hab-its, gentle parental guidance is needed to resettle. Over time this leads to a strong, self-settling child who can calm him or herself when challenges arise.讓寶寶自己哭會增加他的壓力程度，常常會讓他醒來更久，這不會教他心理上及生理上學會自我控制悲傷並回應的目標。相對的，發展好的或健康的睡眠習慣，溫柔的引導他平靜是必要的，日後這會帶來強壯的、自我安定的小孩，當挑戰出現時能夠自己保持平靜。
Understand why some babies fuss more at night than other babies.
Fussing upon awakening is a perfectly normal behavior. When babies are dis-tressed they are indicating a need for at-tention, often to help them recover a feel-ing of security. It is, however, important to understand that babies differ in what makes them feel secure.
Because some infants don’t cry very much or very forcefully, some people develop the expectation that all babies can/should be like that. But babies vary greatly in terms of how often and how hard they cry. These differences are driven by many factors, including tempera-ment, experience and physiological maturity. Thus, the need for ex-ternal regulation (calming) continues in varying degrees for different babies.
Providing external regulation for babies who feel less secure, and thus more distressed, actually helps them, not hinders them. It helps them build the neural pathways that eventually enable them to deal with stress and calm themselves (Cassidy, 1994; Stifter & Spinrad, 2002).
對於較少安全感而較易悲傷的寶寶，提供外界協助能確實幫助他們而不會阻礙他們，這可以幫助他們建立神經通道讓他們往後可以處理壓力並自我平靜。 (Cassidy, 1994; Stifter & Spinrad, 2002)
Understand when waking is a problem.
Waking is a normal part of infant sleep, and varies based on several in-fant factors: (a) feeding method (breast or bottle), (b) age, (c) shifts in developmental levels, and (d) individual level of maturity. In light of these factors, every family must determine whether an infants’ waking is a problem for the family. Waking isn’t a problem just because it hap-pens. To suggest waking defines “problematic sleep” does not accurately reflect current science.
醒來是嬰兒睡眠的正常現象的一部分，而會基於一些嬰兒因素而變化：(a) 餵奶法 (親餵 或 瓶餵)，(b) 年紀，(c) 發展階段的變化，(d) 個人成熟度。依照這些因素，每個家庭需要確定什麼情形下嬰兒醒來對你家來說是個問題，把醒來定義成 “有問題的睡眠” 並不符合現今科學。
We know that it is normal for infants to wake several times in the night, espe-cially if breastfeeding. And given that human babies are neurologically imma-ture at birth, awakenings are the infants’ major line of defense against dangerous, prolonged breathing pauses and permits oxygenation. Moreover, transient and more prolonged awakenings can help respond to cardiopulmonary challenges while asleep and restore a more natural heart rhythmicity (Mosko et al., 1997a).
我們知道嬰兒晚上醒來幾次是正常的，特別是親餵時。因為人類寶寶出生時神經尚未成熟，晚上醒來對寶寶是對於危險的持續性呼吸中止的保護機制，以確保獲得足夠氧氣，此外，短暫的或延長的醒來可幫助回應睡著時心肺功能的挑戰，並恢復更自然的心跳節律。 (Mosko et al., 1997a)
Recall that the early research on sudden infant death syn-drome (SIDS) revealed that in-fants who woke frequently in the night were less likely to die of SIDS than those who awak-ened significantly less often (see review in McKenna 1995 and Mosko et al., 1997a and b).
回想早期關於嬰兒猝死症(SIDS)的研究指出，夜間較常醒來的嬰兒，比起很少在夜間醒來的寶寶，發生SIDS的機率較低。 (請看review in McKenna 1995 and Mosko et al., 1997a and b)
After babies are beyond the age of chief risk for SIDS and their waking and sleeping is settling into more of a consistent pattern, research shows that many continue to wake in the night (Weinraub et al., 2012).
即使寶寶過了SIDS的高風險年紀，且他們的睡眠與醒來已有較穩定的模式，研究顯示很多寶寶還是會在夜間醒來。(Weinraub et al., 2012)
Even then it may be more helpful to frame the night waking as a family problem rather than as a child’s “sleep problem.” If a parent is OK with a baby waking two or more times a night at 12 months then there is no problem!
將夜間醒來當成家庭問題而不是小孩的 “睡眠問題” 或許較有幫助，如果父母對於12個月大的寶寶晚上可能醒來2次或多次覺得OK，那就是沒有問題！
Calming Ways to Calm Babies
The first three months of life is known to many as ‘The Fourth Tri-mester” and requires similar care to the womb. Some babies make the womb-to-world transition easily, others less so. Many of the ways parents naturally try to calm babies actually re-create many of the comforting, familiar expe-riences infants had during their time in utero. For all ba-bies, these calming techniques can be very comforting.
The womb is a constantly mov-ing space and babies tend to respond by calming to move-ments, such as dancing, sway-ing from side to side, going for an exaggerated quick walk, or bumpy car ride.
Rely on touch; provide skin-to-skin contact.
依賴撫觸；提供肌膚接觸 (skin to skin)
Being in contact with warm, naturally (un)scented, skin is proved to be calming for infants/babies, it helps to stabilise their body tem-perature, heart rate and stress hormones, and stimulates the release of oxytocin—the love and bonding hormone–in parent and baby both.
Recreate familiar sounds.
The babies’ time in the womb was marked by many rhythmic sounds. Sounds similar to those babies heard in the womb can be very calming. White noise offers constant surrounding sounds while also slowing brain wave frequencies.
Help the infant learn to deal with sensations of hunger.
Hunger is a new sensation for infants—and infants may find it hard to calm when they feel hungry. Feeding babies when they wake at night can help babies transition back to sleep, especially when lighting and interaction are kept at low levels of stimula-tion. Babies also find sucking to be the ultimate relaxation and comfort tool, one of their few forms of self-initiated self-regulation. Sucking helps a baby’s skull bones to return to their normal position after birth as well as providing them with com-fort and security. Some infants/babies respond to sucking on a dummy/pacifier as soothing (but avoid this in the early weeks of breastfeeding as it can pose problems establishing breastfeeding).Non-nutritive suckling on the breast is also calming.
Sleep Routines that Can Help Calm Babies
Keep babies close.
Keeping babies close helps in shared breathing, touch, warmth, and awareness of any difficulties. Babies are generally much calmer and sleep more easily if they are sleeping with their caregivers or in very close proximity. Babies can benefit from the shared breathing (and general sensory exchanges) with the caregiver including skin-to-skin contact and this can be achieved to varying degrees de-pending on the overall safety conditions including keeping the infant on a separate surface next to your bed, a behavior called separate-surface cosleep-ing.
保持靠近寶寶有助於分享呼吸、接觸、溫暖、以及發現任何困難。如果寶寶和照護者一起睡或保持接近距離，寶寶通常感到更平靜且更容易睡覺。寶寶能從和照護者共享呼吸(以及一般知覺交換)而獲益，包含肌膚接觸，這可視整體安全條件有不同程度的達成方法，包含讓寶寶睡在靠近自己床的分離表面上，這叫作separate-surface cosleep-ing (分離表面的一起睡)(圖片範例連結)。
Many breastfeeding mothers find that intermittent bedshar-ing helps them continue breastfeeding, especially if they work during the day. Bedsharing (while the American Academy of Pediatrics cur-rently recommends against it) not only increases sleep time both for mothers and babies, but has the effect of increasing the chances that mothers will breastfeed for a greater number of months than if they place their infant elsewhere for sleep.
很多親餵媽媽發現間歇的同床睡幫助他們繼續親餵，特別是如果他們白天有在工作。同床睡 (雖然美國小兒科學會現在並不建議它) 不僅增加媽媽及寶寶的睡眠時間，也能增加母親能夠親餵的月數(延長泌乳期)，比起和寶寶分開睡時。
Close proximity usually means night feeds are much easier, there are more of them, and they are far less disruptive for parents and infants, and thus can be more settling. That said, just as with any sleep arrangement, bedsharing does carry risks (as does sleeping away from the baby), and there are very clear circumstances that we know that make bedsharing not advisable.
When bedsharing should be avoided.
It is important for the caregivers to refrain from bedsharing if they are not breastfeeding, and obviously if any adult is under the influence of alcohol, drugs, or anything than may impair their natural arousal patterns. Surely, babies should sleep alongside the bed on a different surface (a) if adult bedsharers are excessively sleepy, (b) if smaller children are likely to find their way in to the parents’ bed, or (c) if there is another adult present in bed who refuses to take any responsibility for the infant.
在非親餵時，有以下情況下避免同床睡是很重要的，當有任何大人受到酒精、藥物或其他任何會妨礙自然醒來的事物影響時。當然，寶寶應該睡在靠在床邊的不同表面上，在以下情形時：(a) 若同床大人會睡得非常熟。 (b) 若有較小的小孩有可能有辦法跑到父母床上。 (c) 若有另一個大人也同床但拒絕對嬰兒負任何責任時。
Bedsharing should be avoided if mothers smoked during preg-nancy because infant arousal patterns may not be as efficient as they should be for maximum safety in a bedsharing envi-ronment. The same holds true for small premature infants. They are safest sleeping alongside the bed in a different sleep structure rather than in the bed. And, finally, it is highly risky to fall asleep with an infant on a couch, sofa or armchair as many infants have suffocated by being trapped between the adult and some part of the furniture. In all these cases, co-sleeping (different surface, same room) is more advisable than bedsharing.
為求最大安全的同床睡環境，如果媽媽懷孕時有抽煙應該避免同床睡，因為嬰兒喚醒父母的能力可能較差。較小的早產兒也是如此，讓他睡在靠床邊的分離睡床上而不是同一張床最安全。最後，和寶寶在睡椅、沙發、扶手椅上睡著是非常危險的，因為寶寶可能會被大人及家俱的某部分堵塞住呼吸而窒息。以上這些情況，比較建議一起睡 (不同表面，同房間) 而不是同床睡。
Finally, wherever an infant sleeps they should always be placed on their backs. Moreover, if sleeping with or away from caregivers, in-fants should be positioned away from soft bedding, pillows, or toys and be situ-ated so that breathing is never obstruct-ed, with their heads never covered.
More on safe cosleeping here (and below in the references).
In addition to all its other associated benefits to infant health and cognitive development, breastfeeding is an excel-lent way to calm a baby. It provides skin-to-skin contact and warmth. Breastfeed-ing can be of benefit to the caregiver as well, making wakings easier to manage and helping to reduce postnatal depres-sion (Dennis & McQueen, 2009; Ferger-son, Jamieson, & Lindsay, 2002; Kendall-Tackett, 2007). In one recent study, mothers who exclusively breastfed actually got more sleep and were less tired during the day than mothers who either exclusively formula fed or both breast-and formula-fed (Kendall-Tackett, Cong, & Hale, 2011).
除了有嬰兒健康及認知發展上的好處之外，breastfeeding(親餵哺乳)是安撫寶寶的絕佳方法，它提供肌膚接觸與溫暖，並且也對媽媽有好處，能讓夜間醒來更簡單應對並幫助減少產後憂鬱。(Dennis & McQueen, 2009; Ferger-son, Jamieson, & Lindsay, 2002; Kendall-Tackett, 2007) 在一個最近的研究指出，全親餵的媽媽實際上得到更多睡眠並在白天較不累，比起全配方奶的媽媽或兼用親餵及配方奶的媽媽。(Kendall-Tackett, Cong, & Hale, 2011)
Listen to the baby & trust your caring instincts.
Babies are master communicators, just as adults typically are mas-ters at figuring out how best to respond. Adults don’t learn to rock a baby or to talk softly…these come naturally. So to calm babies, it is helpful to follow the baby’s lead and follow one’s heart. Parents need to learn to follow their hearts and keep babies safe and healthy. If holding the baby seems to cause distress, then parents can stay with them, but place them in a position that seems more helpful. If the parent is still, perhaps walk; if the parent is already moving, perhaps rock. Parents should trust their instincts in how to be present with the baby.
Note for Parents
There is only one expert in caring for your baby–you. Sometimes you will find a way to calm your baby easily. Sometimes it may seem like what worked before doesn’t work now. Being patient with your baby and yourself will help you both learn and grow.
What If the Routine Is Still Stressful?
A time may come when a parent starts thinking, “I’ve been doing night-time comforting for quite awhile now. Is there anything I can do to move towards getting some uninterrupted nights?”
The answer is yes. Partly it comes with time–varying times for dif-ferent babies as Weinraub’s recent study showed. And there are some things parents can do to gently move in that direction with the baby. We will share some ways to help babies need less atten-tion at night, if that is something that is essential for a family’s well-being. These approaches will build on the essential steps for calm-ing discussed here:
♡ Listen to the baby’s signals
♡ Provide nurturance and support
♡ Help babies help themselves calm.
◎ Educating the Experts – Lesson One: Crying
3. during baby training that he has given up or learned that he will not be attended to. ...In short, not responding to an infant’s attempt at communication will cause them to give up at the very least and possibly demonstrate long-term learned helplessness. This type of non-crying is damaging to a baby’s long-term psychological well-being, no matter how beneficial it may be for mom and dad in the present moment.
寶寶因為被訓練而放棄哭，或者他學到了沒有人會來幫助他。 簡而言之，不回應寶寶的溝通嘗試，會使他放棄哭並可能表現出他學到的長期無助感，這種類型的停止哭泣會傷害寶寶的長期心理健康，無論它對於父母帶來多棒的立即好處。寶寶不哭了絕對不是因為他學會了訓練專家說的 “自我安撫”。
(註： “教導訓練專家” 系列文一共 5篇，以科學的角度指正一些嬰兒訓練書籍的錯誤資訊，其中點名了《Secrets of the Baby Whisperer》《超級嬰兒通》” 這本書，這本看似為溫和派的訓練書籍，因為違反學理且實行上常造成不良結果，因此負評很多，AMAZON書評平均分數為 3.7星。對照組：《Dr. Denmark Said It!》，台灣名書《百歲醫師...》的資料來源，Dr. Denmark即為百歲醫師，這本書的評分為 3.8星，也是因為違反科學且對嬰兒有害，因此負評很多。)
◎ 教導訓練專家－第三課：Touch (中文翻譯)
◎ Educating the Experts – Lesson Four: Self-Soothing
Emotion regulation, being a complex and difficult task at the best of times, is something that is most likely far beyond the reach of any young infant. Children take time to learn how to regulate their own emotions, and this may take place at different time points for different types of regulation.
◎ Educating the Experts – Lesson Five: Schedules
強迫寶寶在不想睡覺時要他睡覺，或是在他想睡覺時讓他撐久一點讓他清醒，會傷害親子關係造成寶寶更愛哭鬧，並且有造成SIDS (嬰兒猝死症)機率增加的風險。此外，比起依訊號餵奶 (feed on-cue，意思同feed on demand，即想喝就餵，餓了就餵，但feed on-cue一詞有強調觀察寶寶餓了的cue=訊號之意思。)，依照Schedule (時間表)定時餵奶的寶寶，其喝奶量較少，體重成長較慢，並且不利於母乳產量 (親餵次數頻繁，並在晚上寶寶醒來時餵奶，有助於奶量增加)，而在另一篇網誌 “瓶餵與親餵的不同 & 如何改善瓶餵”中也有提到，研究指出餓了就餵的寶寶比起依時間表餵奶的寶寶，有較好的認知發展與智商。
◎ 7 Benefits of Sleeping Close to Your Baby
◎ Scientific Benefits of Co-Sleeping
11 Benefits of Co-Sleeping
6 Ways to Help a High Need Baby go to Sleep and Stay Asleep
為什麼Cry It Out及睡眠訓練技術對寶寶有害 (百歲法、費伯法等)
Gentle Sleep Resources
Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228-283.
Davidov, M. & Grusec, J.E. (2006). Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Development, 77, 44-58.
Dennis, C.-L., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123, e736-e751.
Fergerson, S.S., Jamieson, D.J., & Lindsay, M. (2002). Diagnosing postpartum depression: can we do better? American Journal of Obstetrics and Gynecology, 186, 899-902.
Hunziker, U.A., & Barr, R.G. (1986). Increased carrying reduces infant crying: A randomized con-trolled trial. Pediatrics, 77, 641-648. ftp://urstm.com/CharestJ/Articles.pdf/Hunziker%20U%201986.pdf
Kendall-Tackett, K. A. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Jour-nal, 2:6 http://www.internationalbreastfeedingjournal.com/content/2/1/6
Kendall-Tackett, K.A., Cong, Z., & Hale, T.W. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lac-tation, 2(2), 22-26. [click here]
Mao, A., Burnham, M.M., Goodlin-Jones, B.L., Gaylor, E.E., & Anders T.F. (2004). A comparison of the sleep-wake patterns of cosleeping and solitary-sleeping in-fants. Child Psychiatry and Human Development, 35, 95-105.
McKenna, J.J. (1995). The potential benefits of infant-parent co-sleeping in relation to SIDS prevention, In T. O. Rognum (Ed.), SIDS in the 90s. Scandinavian Press.
McKenna, J.J., & Mosko, S. (1990). Evolution and the sudden infant death syn-drome (SIDS) Part II: Why human infants? Human Nature, 1 (2).
McKenna, J.J., & Mosko, S. (1990). Evolution and the sudden infant death syn-drome (SIDS), Part III: Parent-infant co-sleeping and infant arous-al, Human Nature, 1(2).
McKenna, J.J., & Mosko, S. (2001). Mother-infant cosleeping: Toward a new scientific beginning. In R. Byard & H. Krous, (Eds.), Sudden Infant Death Syndrome: Puzzles, problems and possibilities. London: Arnold Publishers.
Mosko, S., Richard, C., & McKenna, J. (1997). Infant arousals during mother-infant bed Ssharing: Implications for infant Ssleep and SIDS re-search, Pediatrics, 100(2), 841-849.
Mosko, S., Richard, C., & McKenna, J. (1997). Maternal sleep and arousals dur-ing bedsharing with infants, Sleep, 201(2), 142-150.
Stifter, C.A., & Spinrad, T.L. (2002). The effect of excessive crying on the develop-ment of emotion regulation. Infancy, 3, 133-152.
Weinraub, M., Bender, R.H., Friedman, S.L., Susman, E.J., Knoke, B., Bradley, R., Houts, R., Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age. Developmental Psychology, 48, 1501-1528.
*NOTE: Many of the references are available at: www.cosleeping.nd.edu, where there are extensive details and conversation pertaining to the safety and controversy of bed-sharing, covered both by an interview and the FAQ section of the website.
Professor of Psychology
University of Notre Dame
Associate Professor of Educational Psychology
University of North Texas
Clinical Associate Professor of Pediatrics
Texas Tech University School of Medicine
Safe Sleep Space
Professor of Anthropology, University of Notre Dame
University of British Columbia