Diary of a Night Nanny
The story so far: I am working for a few weeks as a maternity nurse for Debbie, a first time mother whose baby is only a week old.
Debbie, Josh and I are all learning about each other. Debbie has settled into a good routine of having a rest after lunch which means she is generating a good supply of milk for the late afternoon and evening feeds, and Josh seems to have worked out very quickly how to latch on and feed effectively. One morning, while Josh is sucking furiously, Debbie brings up the subject of dummies. “Someone at the NCT group mentioned that they are recommended to reduce the risk of cot death, but I didn’t take much notice. I was determined that my baby wouldn’t end up being glued to his dummy until he was 18,” she laughs, “but I wonder if there is more to it than that. Do you know anything?”
“It is actually relatively simple, if you start from the beginning, if you know why you are using a dummy and if you stick to the rules,” I explain. Keeping it as straightforward as possible, I tell Debbie about the results of the Foundation for the Study of Infant Death (FSID) research. If you start using a dummy at around one month old, just to settle a baby to sleep at the beginning of each of his sleep periods and do not re-insert it when it falls out, you will reduce the risk of cot death. You need to keep using the dummy in this way until your baby is one year old, at which point the risk has passed and you can stop using it. You should not force your baby to use the dummy if he seems not to like it.
She looks at me in horror and amazement. “But …” she stops herself and I can see the questions flying around in her head. I laugh. “I know,” I say, “it sounds too easy and yet we all know how complicated it becomes!”
“But just tell me why it works, first of all,” Debbie asks. The research into Sudden Infant Death Syndrome (SIDS) is a tricky area to be specific about because no one knows quite how or why SIDS occurs. All we can say for sure is that, since Anne Diamond joined forces with SIDS to raise its profile in 1991 when her son Sebastian died suddenly and inexplicably, cot deaths have been reduced by 70% and following the guidelines is thought to have saved the lives of 20,000 babies. “Regarding the available information on dummy use,” I tell Debbie, “when a baby settles himself to sleep and is sucking on a dummy, you can watch him suck really hard to start with and gradually the speed and strength of the suck will diminish. This reflects other things which are happening in his body – his breathing and heart rate will be slowing down, thus easing him into sleep. It is thought that this gentle, controlled transition is good for avoiding cot death. Also, if a baby is sucking on a dummy, he will need to be breathing through his nose. Air brought into a baby’s body via the nasal tubes is warmed and filtered before it reaches the lungs and this, too, may have a beneficial effect.”
“I obviously want to do what is best for Josh,” says Debbie, “but how do I stop him becoming dependent on the dummy?” I explain again the crucial phrase in the SIDS literature. “You only use the dummy to settle him when he goes to sleep. So in the early days, from one month old, he will be mainly sleeping and feeding. You put the dummy in, if he wants it, once you have fed, winded and settled him. Then you leave it. If it falls out, that’s fine – you don’t put it back again. I can’t emphasise that enough.” I tell Debbie that a good rule is to have a dummy in the bedroom to use in the cot, and not to have them anywhere else in the house. “Use it like a sleep association,” I suggest. The key is not to be fooled into using the dummy as a settler at any other time. As he gets older, he will spend time awake between feeds, his sleep times will become more structured and he will probably nap in his cot. “So at the beginning of each nap and at the beginning of his overnight sleep, you put the dummy in – but you don’t re-insert it if it falls out!”
“Okay, okay, I’m getting the message!” laughs Debbie. “It seems simple enough. And you would recommend this, would you.” “Of course,” I say, without hesitation. “It has been proven by SIDS – I wouldn’t be much of a professional if I didn’t follow proven guidelines.”
Debbie looks down at Josh, whose furious sucking at her breast has reduced now to a more sedate pace. “I can see what you mean about the sucking rate slowing down his whole body,” she remarks. “I can feel him much more peacefully in my arms now than when he was hungry 20 minutes ago. His muscles just seem more relaxed and everything about him is calmer.” That is certainly true. He looks satiated and before he falls completely asleep in Debbie’s arms I take him from her to wind him and change him. “Oh, don’t wake him up,” pleads Debbie. I reassure her. “Don’t worry, he’ll fall asleep again very quickly – he has had enough milk and now needs to sleep, but it is important to let him settle himself. If he falls asleep on the breast and we then put him down in his cot, he won’t know where he is when he wakes up. He needs to be put down awake and allowed to fall asleep on his own – it is a really important skill to give him and will avoid all sorts of problems in future.”
Having winded Josh, we take him upstairs and change his nappy. A heavy one, it tells me that Josh’s digestive system is working properly and he is having plenty of nourishment from his mum. Debbie swaddles him deftly, then gives him a kiss on his forehead before putting him into his cot. “Sleep well,” she says, then leaves the room. Josh glances at me as his eyes close peacefully – he can’t keep himself awake a moment longer.
For more information on anything mentioned in this article contact Georgie Bateman at Night Nannies on 01794 301762 or firstname.lastname@example.org. The website is www.nightnannies.com. Information on infant death is available from the FSID, 020 7222 8001 or www.fsid.org.uk.