What to Expect the First Year (71 page)

“My baby is awake more, much more, during the day and I'm not sure—and I don't think he is either—how many naps he needs, or how long each one should be.”

Remember when you brought your little bundle home from the hospital? You'd stand over the bassinet all day, watching his sweet slumber, wondering when your cutie would wake up so you could play and cuddle with him. Fast-forward a few months, and now you're aching for a nap (or at least a few minutes off baby duty)—and wondering when he'll take one, too, and how long the snooze will last.

Though the typical baby in the fifth month takes 3 or 4 pretty regular naps of an hour or so each during the day, some babies thrive on 5 or 6 naps of about 20 minutes each, and others on two longer ones of 1½ or 2 hours. The number and length of naps your baby takes, however, are less important than the total amount of shut-eye he gets (about 14½ to 15 hours a day on average during the fifth month, with wide variations from baby to baby), and how well he does on the sleep he gets. Longer naps are more practical for you—nobody needs to tell you this—because they allow you longer stretches in which to get things done. Another reason to encourage longer daytime naps? A catnapper during the day may follow the same pattern at night, waking up again and again. Getting your little one used to longer daytime naps may increase the chances for a better night's sleep for you.

Here are a few strategies to use to try to extend nap time:

Choose a good napping location.
Comfort is key to a longer nap, so make sure your baby drifts off in a place where he can happily snooze for a solid while (his crib, that is, as opposed to your shoulder). Of course, occasional naps in the stroller or car seat are inevitable and fine, but don't substitute those spots for the crib (or pack-and-play) on a regular basis.

Choose a good naptime.
As always, the best time to schedule a snooze is when baby is getting sleepy but not once he's crossed that fine line to overtired. So look for those snooze clues—they're his body's way of telling you it's time for a nap.

Think ahead.
A little advance planning can translate into many more minutes asleep, so avoid these surefire nap killers: an empty tummy (he'll probably wake up too soon … and crabby), a very wet or full diaper (try to put him down with a clean one if possible), a too warm or too cool environment (or an outfit that's too heavy or too light for comfortable sleep).

Ease into nap mode.
It's hard to drift off to dreamland when you've just been scooped up from your toys and swept off to your crib. Instead, allow a little buffer time for your baby, so he can wind down, mellow out, and get in a sleepier state of mind. Set a sleepy mood, too, by dimming lights, putting on some soothing music, and giving your baby a relaxing massage. The more alert and active your little one becomes, the more transition time he'll need before naps.

Run interference.
If your baby wakes (or cries) 20 minutes into his nap, try to encourage a longer snooze by offering some gentle strokes and soothing words—without picking him up. If soft music is the key to summoning his sandman, put it on to help him fall back asleep (or turn on the white noise). Once he realizes that play is not in the plan right now, chances are he'll drift off once again.

Increase baby's awake time.
By 4 or 5 months, you can expect your baby to be able to stay up for 2 to 3 hours at a stretch. And the longer your baby is awake between naps, the longer he's likely to sleep once he goes down. Try any of the infant-stimulating ideas
here
and
here
to increase stay-awake time—so you can consolidate stay-asleep time.

Though many babies regulate themselves pretty well when it comes to getting their quota of sleep, not every baby gets as much as he needs. How can you tell if your little one is cashing in on that quota or falling short? Look to his mood—a baby who's mostly happy is most likely getting enough nap time, while one who's chronically cranky probably isn't. Your baby sleeps very little, yet seems perfectly content, active, and alert? He may just be one of those babies who need less shut-eye.

“My baby has begun to break out in a red rash on her cheeks. It must be itchy, because she keeps trying to scratch it.”

What's smooth, silky, soft … and suddenly dry, flaky, and rashy red all over? Baby skin that has been hit by eczema, that's what. Eczema usually appears in patches, starting at about 2 to 4 months, in very visible places, such as those chubby cheeks, behind the ears, and on the scalp. Then it typically spreads south to the elbow creases, behind the knees, and sometimes even to the diaper area. The flaky skin gets redder, and small pimples pop up, fill with fluid, and then burst. Baby eczema isn't pretty, and yes, it's very itchy for your little one. Happily, however, it isn't dangerous or contagious, and it usually resolves itself.

Eczema is the term doctors use to describe both atopic dermatitis (a typically inherited chronic condition more common among babies with a family history of allergies, asthma, and eczema) and contact dermatitis (when skin comes in contact with an irritating substance). With contact dermatitis, the rash usually clears when the irritant is removed (a stubborn case can be treated with hydrocortisone cream or ointment). Treatment for atopic dermatitis that doesn't go away on its own includes hydrocortisone cream or ointment and possibly antihistamines to reduce the itching.

On the home front, it's important to:

• Keep baby's nails short to prevent scratching. You may be able to prevent her from scratching while she's sleeping by covering her hands with a pair of socks or mittens (built into some long-sleeve sleepers).

• Gently pat drool away whenever you see it, because excessive wetness can set off an eczema outbreak.

• Limit baths to no longer than 10 or 15 minutes, and use an extra-mild soap-less cleanser (Aveeno or Cetaphil, for example) only as needed. Occasionally, sprinkle a pinch of baking soda, a handful of uncooked rolled oats (not instant), or colloidal oatmeal (made specifically for baths) into baby's bath water (put the oatmeal in a sock or fine mesh bag to contain it). All are natural eczema treatments.

• Limit dips in chlorinated pools and salt water.

• Pat—don't rub—skin dry, and apply plenty of rich hypoallergenic moisturizer (like Aveeno, Eucerin, Lubriderm, or Aquaphor) after baths, when skin is still damp.

• Minimize exposure to extremes in temperature, indoors and out. Think layers when dressing your little one so you can remove one or more if things get too toasty (sweating can reboot the eczema cycle).

• Use a cool-mist humidifier (clean it frequently to prevent bacteria or mold buildup) to prevent dry indoor air. But don't overdo the humidity in your home, because it can lead to mold and mildew, common allergy and asthma triggers.

• Dress your baby in the softest cotton knits (rather than wool or synthetics), avoiding clothes that are scratchy against sensitive skin. Wash new clothes as needed to soften them up before baby wears them.

• When your baby plays on carpeting, which can irritate the skin, too, place a cotton sheet under her.

• Switch to detergent that's fragrance-free and meant for sensitive skin.

• Eliminate any food that seems to trigger a flare-up or a worsening of the rash—sometimes just topical exposure to an irritating food (she smears tomato sauce on her face) can set off a reaction.

• Ask the pediatrician about probiotics, which have been shown in some studies to reduce the incidence and severity of eczema in some babies.

“How will I know if my son is allergic to certain foods? It seems everyone's baby has some sort of allergies these days.”

About 8 to 10 percent of children under 18 have food allergies—with the most common offenders being milk, eggs, nuts and peanuts, soy, and wheat. Those babies with a family history of allergies tend to be the ones most at risk of developing allergies—so if you or your spouse (or both of you) have allergies, asthma, or eczema, chances are higher that your baby will have allergies, too.

A baby becomes allergic to a substance when his immune system becomes sensitized to it by producing antibodies. Sensitization can take place the first time his body encounters a substance or the hundredth time. But once it does, antibodies rev into action whenever the substance is encountered, causing any one of a wide range of physical reactions, including runny nose and eyes, headache, wheezing, eczema, hives, diarrhea, abdominal pain or discomfort, vomiting, and, in severe cases, anaphylactic shock.

Not every adverse reaction to a food or other substance, however, is an allergy. What appears to be an allergy may sometimes be an enzyme deficiency that triggers an intolerance. Babies with
insufficient levels of the enzyme lactase, for example, are unable to digest the milk sugar lactose, and so they react badly to milk and milk products. And those with celiac disease are unable to digest gluten, a substance found in many grains, and so they appear to be allergic to those grains. The workings of an immature digestive system or such common infant problems as colic may also be misdiagnosed as allergy. If you suspect a food allergy, consult with your doctor or a pediatric allergy specialist. They can do tests to help determine whether your baby has a true food allergy or other issue (such as lactose intolerance).

There's not much you can do to prevent allergies in your little one if he's predisposed to having them, though studies do show that breastfeeding your baby for at least 6 months and ideally a year or longer will help keep allergies at bay. For high-risk formula-fed babies, a hydrolysate formula may be recommended over regular formulas (including soy-based ones). When it comes to solid food introduction, it was once common to delay giving a baby certain foods like dairy, eggs, seafood, and nuts in the hopes of staving off allergies, but the AAP no longer recommends that since the data shows that holding off on certain foods does not prevent food allergies. Most pediatricians do say, however, that you can lower your baby's risk of developing food allergies if you wait until he's 6 months old (instead of 4 months) to start solids. Not so sure what's best for your baby? Check in with the doctor.

If a true allergy exists, you'll need to keep your baby away from the offending food (sometimes just touching it or even inhaling its scent can be dangerous). You'll need to become an expert at reading labels and screening foods at playgroup, plus you'll want to come up with a response plan in case your baby is accidentally exposed to the offending food. Be sure to share this plan with anyone who cares for your baby, including regular childcare providers, occasional babysitters, and family members, so they'll know what to do in case of an emergency.

The good news is that food allergies are often outgrown during early childhood. Experts say that 80 to 90 percent of egg, milk, wheat, and soy allergies disappear by age 5.

“My baby loves being in her infant swing—she can spend hours in it. How much time can I allow her to spend swinging?”

Being in the swing of things is entertaining and soothing for baby, and convenient for you when your arms are otherwise occupied, but it does come with a downside. Too much swinging can prevent your baby from practicing important motor skills, such as creeping, crawling, pulling up, and cruising. It can also cut down on the amount of contact your baby has with you—both physical (the kind she gets from being held by you) and social (the kind she gets from playing with you).