At Home with Our Little (Newborn) Girl

During my 5th year of graduate school, my Better Half gave birth to our first child. Becoming a father was the moment where I considered my life as complete as it could be.

Hey Baby! Hanging out with my Little Girl.

I worked to shift my work-life priorities so that I could be more present for my family. My Better Half stayed home with our Little Girl for 12 weeks after giving birth, and during this time, we talked about me also staying home with our Little Girl two days a week for a few months after my wife returned to work full-time. Those Tuesdays and Thursdays meant so much to me that thinking about them always makes me cry. I miss those days so much.

Snuggled up for a walk around the neighborhood.

For most of March and all of April 2012, I had a chance to do it all with my Little Girl. Messy meals, naps that never happened, naps that lasted for hours, inconsolable missing mommy moments, giggles for reasons only she knew, walks around the neighborhood, silly pictures, and dirty diapers. There were moments I was scared and worried that I could not do it, but those moments faded the longer I had the chance to figure it out (mostly) on my own.

Being with her, learning her faces, needs and dislikes; it gave me a strong base to build upon.

I had a big conference presentation to prepare for in mid-May, so my Better Half and I talked about transitioning our Little Girl to daycare 5 days a week so that I could focus more on my research. This was a decision that sort of had to happen, but it was still a really hard one to make. I remember sitting there the first Tuesday without my baby not wanting to write or read anything and thinking how much I missed her stinky diapers, her way of hamming it up when she wanted something, and her way of being her self with me in those small moments.

The process of parenting often feels fraught with doubt, but I felt so grateful and blessed to be able to stay at home two days a week with our Little Girl. I know this experience made me a better therapist, too, as it deepened and broadened the base of experiences I can draw upon when relating to caregivers who spend longer stretches of time at home with their children.

Product Review: Teach Me Time Clock

Last week I posted about Bedtime Routines. I wanted to share an accompanying product review of something I have and use daily in my home, along with some ideas on how I use it to improve my kid's sleep. 

Sleep can be challenging at different stages of development for a variety of reasons. Sleep can also be a sensitive subject for caregivers and healthcare providers alike when it comes to improving the onset (how long does it take to fall asleep) and increasing the duration (how long do they stay in bed asleep). At the end of the day, we all need sleep to function, so I’ve talked about it often with my friends and with families I have worked with over the years.

So...my cherubic first born child learned to sleep through the night at a young age. This is something we took relatively for granted until our second child arrived 22 months later. Just about the time our 2.5 year old transitioned to her big girl bed, she started developing the fabulous habits of A) getting in and out of her bed repeatedly and B) waking up too early. By my math, she was losing anywhere from 60 to 120 minutes of sleep on the front and back ends.

We needed to shore this issue up in a hurry since it was ratcheting up the household stress.

Like most things in my life, my Better Half deserves a lot of the credit. She read about this product, we purchased it, and had it all set to go atop the dresser in our daughter’s bedroom:

Teach Me Time Clock can be purchased on Amazon. This is the nightlight ("stay in bed") mode.

Here’s what the Teach Me Time Clock can do:

• Tell time
• Work as a traditional alarm
• Provide touch-button voice-over to speak actual time
• Serve as a nightlight
• Change colors at different times (this is the key ingredient).
• Here are our current settings:
  • 7:30pm - soft yellow light comes on (serving as a nightlight)
  • 8:00pm - soft yellow light continues on (time for bed)
  • 6:45am - soft green light comes on (indicating time to get up)
  • 8:00am - soft green light turns off (nobody is asleep at this time...)

So our daughter used to wake up around 6:30am, but was now waking up at 5:30am. She used to go to bed around 8pm with little fuss, but now was getting up and down until close to 9pm.

This is what we needed to do:

• Talk about the clock to her, the colors, and what she could earn for following the rules
• Identify a strong motivator soon after the light changes (morning tv show)
• Tell her what she would get for staying in bed until the light turned green (tv show)

The careful reader will likely notice that I have said nothing about getting her to stay in bed in the evening without getting up and down a bunch. I believe the the venerable Sun Tzu put it best when he said, in different words, “never fight a war on two fronts.” Sage advice here.

It would’ve been amazing if this took only one evening to do the trick. Of course, it did not.

What we needed to do was set the clock to 5:45am (close to her new 5:30am awake routine) and then gradually move the time toward our 6:30am goal in 10-15 minute increments over a few weeks. In addition, she would often wake at 5:30am, come get one of us, and then want to go watch her tv show. I would take her back to her room, lay her back in bed, and then lay with her until it turned green. I praised her to holy heck, got her dressed, and took her to tv time.

Then we worked on having her lay by herself until the light turned green. Then once this new behavior of laying in bed on her own until the light turn green appeared firmly established, we moved the time forward. This would often reset the level of support back to her needing to be taken back to bed, me laying beside her, then fading my physical presence, and her staying in her bed on her own. Then we’d move the clock forward another increment toward our goal.

Green light means time to get out of bed. "I slept until the light turned green" - parenting win!

What happened if she refused to stay in bed until the light turned green? This is where we would "ride the lightning."

She just didn’t get tv time that morning. And yep, it was not fun for either party.

But she got the hint relatively quickly because we also were not doing tv time in the evening, so this increased the reinforcement value of tv time.

This is one of those parenting battles where I feel like we fought the good fight and won. It wasn’t a one week or even a one month slam dunk, silver bullet sort of deal for us or her. But I do think this alarm clock provided a nice level of cuing and support that we still use with her.

Now we are preparing to transition our son to a big boy bed and will be ordering a second Teach Me Time Clock soon.

Bedtime Routines

I believe our souls call out for consistency in the form of predictable, daily routines. I am sure that life would be boring for most of us if everything was predictable and routine, but when learning something new and potentially challenging (like how to eat or sleep or drive a car), a consistent order and flow gives a comfort that enables new things to come more readily to us.

Bedtime is a ritual that rewards parent and child alike.

For the child, having a bedtime routine signals what to expect as they transition away from the wakeful part of their day where they acquire new skills and encounter new situations at a ferocious pace.  The order in which the routine unfolds matters a great deal, but can vary depending on what you know about your child. For example, certain children become animated during bath time (or don't even like getting their hair wet), while others begin to quiet down and doze. If your child becomes more animated or upset during the bath time routine, starting bath time sooner or only bathing every other night might be an easy place to modify things.

For the parent, having a bedtime routine gives you a chance to gently guide your child toward a restful state that readies them for falling asleep. It also provides an opportunity to lay the foundation for the next day (picking out clothes after looking at the weather on your phone). 

For the parent and child, the bedtime routine provides an opportunity for bonding and more attentively observing the subtle ways in which your child responds to their world and others.

Recommendations to consider with the bedtime routine:

Provide your child with a clear indication of when the bedtime routine will begin. For example, you could say, “In ten more minutes” or “at 7:30, we will get ready for bed." For some children, setting an alarm (fun song) on your smartphone could be a creative support.

Pay attention to how you announce the bedtime routine. For some children, saying, “Time for bed” is the equivalent of saying, “the fun thing you are doing right now (e.g., playing with toys) will have to end soon because I said so.” Instead, try changing the way you state this by using a preferred activity or item as part of the announcement. For example, you could say, “Time for bubble bath!” or “silly story time is soon!” This reminds children of the fun parts of bedtime.

Start the bath early enough that you don’t have to rush your child through it. If your child likes to play in the tub, build in extra time by starting earlier so that they can have more time to play in the bathtub.

A lot of kids have a hard time transitioning from the bathtub to getting dressed and brushing their teeth. In these situations, I'd recommended leading with a clear contingency that gives them something to work for and look forward to. Something like, "Once you hop out of the tub and have your pajamas on, you can pick an extra book!" Help them get dressed and praise them for using nice hands. With tooth brushing, I think having your child pick out a favorite toothbrush from the store and/or a preferred tooth paste container can help make this part of the routine fun.

I really like background sounds or some for of white noise when I sleep, and both of my little ones have a white noise machine in their room. It's also served as a discriminative stimulus for my kids -- sleep machine turned on signals little butts into bed in order to have story time.

Since starting my private practice, I have had the opportunity to work with more than one family to improve their bedtime and sleep routines. I really enjoy this type of work, besides who doesn't enjoy a good night's sleep?

Have on Hand: Extra Socks

Summer fun with kids often includes festivals with bounce houses, playgrounds, bounce pillows, and other play places.  On the one hand, summer often means flip-flops, sandals, and crocs – in other words, footwear without socks.  On the other, “No Shoes” is a pretty common rule when enjoying these different jumping experiences. But socks are usually required.

So my life hack here is a footwear accessory that we forget but often need during the summer.

Socks

On one recent trip, my Better Half sat barefoot while our daughter donned ridiculously large adult athletic socks up to her knees so she could jump to her heart’s delight. We’ve also been squeezed into purchasing overpriced socks just so our kids could participate in an activity. Not to mention that time we got stuck in a downpour and the kids complained about wet socks and shoes the whole ride home.

We’ve since wised up and now keep an extra pair of socks for everyone in the car. My Better Half took it a step further and put an extra pair for both kids in her purse when she knew there was a birthday party soon at one of those bounce places. Luckily, our kids were in sneakers that day and arrived at the party in sock-covered feet. There was a friend who didn’t remember that detail, and we were able to "come to the rescue" with clean socks for them to borrow. So grab a clean pair of socks for everyone and throw them in the car. Maybe even store them in your plastic bag...

Faith in Data

I was first introduced to Dan Habib's work at a film viewing of Including Samuel that he hosted at the Dryden Theater at the George Eastman Museum here in Rochester about 7 years ago. I've followed him ever since, and I recently watched this video about inclusive education which rings true to the ideals many families hold dearly. One comment in the video really struck home because it reminded me of how data helps us know how and when to push and adapt our practices.

“I’m going to push you until you give me what’s inside of you”

— 7:48 minutes into the video

That’s what I’m talking about! And I buy what’s she saying hook, line, and sinker because it’s backed by the collection and recurrent use of data. I’ve been sitting on this idea for a while, and this video has inspired me to write it up. By way of analogy, this quote made me think about my favorite verse in the entire bible: 

“Even so faith, if it has no works, is dead, being by itself.”

— James 2:17

I remember very vividly my sophomore religion teacher, William Jauquet, dropping bible verses on us, and he tersely summarized this verse as “faith without works is dead.” I believe this line wholeheartedly, and I try to apply it to my work as a psychologist as such: “Even so therapy, if it has no data, is non-falsifiable, being by itself.”

So what am I trying to get at here?

I want to provide care that is informed by data and to measure clinical change. This is why I am giving clients and their families forms to complete on a routine basis to help gauge their progress and to better adapt our work together.

Since my practice just started (3 weeks in, hooray!) I am seeing a lot of new clients for the very first time. These intake appointments have been a great opportunity for me to collect data from clients and their families using standardized measures, and to integrate this data into my practice as an index of clinical change. I am working to screen for a range of clinical concerns and to have on-going, data-driven discussions about client's unique symptoms and to measure their personal progress. I hope this data-informed approach will be useful to my clients, and also provide me with real-time feedback so I can better meet their needs.

This is what I would love to hear more about from folks who read this blog:

• What measures do you use as part of your work? Recommend them to me.
• What domains/aspects do you think are important to measure? How do we do this?
• How often is too often/too little/just right for measuring change in your opinion?

I’m wearing my clinical scientist hat here and would love to hear more from you!