Sleep: 18-Month Edition

Well folks, it's happened: The 18-month sleep regression. Or should I say, The Eighteen-Month Sleep Regression.

At least, I assume that's what it is. G is 18 months, and his sleep is worse than a newborn's. For that matter, he's nursing more than a newborn, he's crankier than a newborn, he's crying more than a newborn! I'm very frustrated. I'm stressed out and tired and exhausted and sometimes resentful of him for taking up so much of my time either nursing or crying because he wants to nurse. No exaggeration, he basically nursed from 3:00 to 5:30 this afternoon. Arrrgh!

He's also getting the two bicuspids on the bottom. He has the top two, as well as all eight incisors. None of the other 10 teeth caused nearly this much upset. Since Sunday night, he will wake up crying and literally just scream and cry for an hour. He insists on being held, wants to walk all over the house (at un-G-dly hours, incidentally), and will then suddenly fall asleep against my chest as I sit on the couch. I can then wait a bit for him to fall into a deeper sleep and then lay him in his bed. He'll sleep on his own for a while, maybe two to three hours, and then wake again crying. I've been trying to stay on top of giving him pain medication, but it doesn't seem to help completely. I've never seen anything like it. I'm not comfortable using Orajel or other mouth-numbing products, and while I have two amber teething necklaces, I can't find either one! I don't know if the amber necklaces actually help or not, but I'm willing to try anything to help this kid.

I would ordinarily suspect an ear infection, but he has no other symptoms: he's not congested or coughing, no runny nose, he wasn't sick or congested within the past week or two, and he has no fever, vomiting, or any other obvious distress. Also, he's pretty much fine during the day and this only hits at night.

Crossing fingers, though, tonight seems a bit better so far. Here's hoping!

In any case, here are my plans for the next few months, sleep-wise.

First off, I want to night-wean. Night-weaning is when you no longer allow the baby/child to nurse during sleeping hours. The idea is that if they don't wake to nurse, they won't need to wake at all, and everyone will get more sleep. I also want to encourage him to be eating more during the day, and as long as he's getting a significant amount of his daily calories during the night, he just isn't going to be as hungry during the day. At some point, this nocturnal snacking has to end!

My nightweaning plan is to basically pick three or four nights where I assume I won't sleep (not that I've been getting much sleep anyway!), and just try to soothe him and talk him back to sleep as best I can but not allow him to nurse during defined hours, say 8:00pm to 6:00am or something. There's no reason an 18-month-old can't go 10 hours without eating at night. I don't know how difficult it will be to get him to go back to sleep. I don't know how much he'll cry/whine/insist/yell/scream. Probably a lot. I'm warming up to it, maybe when he gets over this bout of teething. My hope is that once he's night-weaned, he simply won't need to wake as often, or if he does wake, he'll be able to get back to sleep on his own.

Then, after he's night-weaned, the goal will be, of course, to eliminate night-wakings completely. The only way I know to do this is to force him to learn to put himself to sleep. I figure this will require graduated steps beginning with me helping him fall asleep by rocking, patting, or whatever works, and eventually doing that less and less until he's falling asleep without my help.

I do think I need to wait another few weeks, both to make sure those teeth have come in and aren't a factor in his wakings, and also to get through the brunt of this crazy time when his brain is making leaps and bounds and his language ability is exploding and his understanding of the world and his place in it are developing. Perhaps at 19 or 20 months, he'll stabilize enough that I won't need to take drastic measures. But, if I do need to push him a little, I'll feel comfortable knowing that he's at a good age to give it a try.

At least he likes sleeping in his own bed! That change went very smoothly.

Let's share teething stories in the comments here or on the Facebook page. What was your worst teething experience with your kid(s)? How did you handle it? What recommendations do you have for other parents to help soothe the teething pain and help your baby sleep during those few days and nights when a tooth is erupting?

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P.S. Unrelated to the above, but you need to go read Magda Pecsenye's (AskMoxie) letter to her sons about preventing rape.

On Teeth: Second Edition

About six months ago, I wrote a riveting post on teeth, and now that we have returned to the dentist for our regular six-month cleanings, I now have an even more riveting follow-up post for you!

1) GI
GI now has four teeth and is working on two more. He has two on top and two on the bottom, which is great for biting but not for chewing. Both NJ and SB had far more teeth by 14 months, and I'm kind of looking forward, in an odd sort of way, to GI's getting his bicuspids, which typically happens around one year but can be later for some kids. The teething hasn't been a piece of cake, but it hasn't been the hellish experience I expected. He hasn't gotten a new tooth in months, though, just hanging around with these four. Who needs teeth, anyway?

He doesn't bite, really. Sometimes he tries to pull away from the breast without letting go, first, and I yelp, but he's never drawn blood or left marks. Thank goodness.

2) SB
SB has excellent teeth. The dentist told me yesterday that his hygiene is very good. That's good! He chipped a front tooth at some point. I don't even know when it happened! But it's only in the enamel and not the dentin, and the dentist said we can probably just leave it alone.

3) NJ
NJ's got a permanent tooth coming in on the bottom, behind his baby tooth! Oops! I didn't even know! It's already erupted, even! The baby tooth is a little bit wiggly, and the dentist said we should wiggle it and wiggle it and try to coax it out, or else she'll have to pull it to make room for the permanent tooth. I'd hate for him to have to lose his first tooth artificially. I've been looking forward to this milestone.

NJ also has two of his six-year-old molars in, both on top. One has a little cavity. We're going back in a few weeks for a filling and a sealant. I told him, he has to make sure to brush way in the back, now. It's a big responsibility, having permanent teeth!

4) Me!
No new cavities, for a change. How nice for things to settle down for a bit.

I know that one day, we'll be discussing things like braces and more fillings and other expensive notions. I keep praying that my kids have my good oral flora, that breastfeeding SB and GI will help their teeth grow in straight and their bites develop correctly. For now, I'm happy that my kids don't mind going to the dentist and are cooperative and friendly while there. Indeed, NJ said to me, "Do we have to go to the dentist every six months?" I said six months was what they recommend. He continued, "Because I wish we could come once a month!" I guess I'm doing something right!

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On Teeth

Incredibly, GI still has no teeth. I say incredibly, although it's not especially rare for an eight-month-old (well, eight months this coming Saturday) to still be toothless, because both NJ and SB had at least one tooth by this age. I'm enjoying the break before the inevitable teething adventure to come, but GI has been threatening to grow teeth for months now, so it surprises me that he hasn't managed to erupt one or more by now. You can see all eight front teeth just below the gum line just dying to come through, but there are no sharp edges yet!

On the subject of teeth, I took NJ and SB to the dentist yesterday. Both came through with a clean bill of health. NJ doesn't have any wiggly teeth yet, at 5-1/2. I'm not that shocked, since I didn't lose my first tooth until I was seven, but I was kind of hoping. You see, when NJ was about 27 months, he fell and ruined one of his top front teeth. It didn't fall out, but it died, and it's brown. So he's got this brown tooth in front, in an otherwise pristine set of teeth, and I'm looking forward to when he finally loses it naturally and grows in a beautiful, white permanent tooth. SB's teeth are gorgeous, white, pearly things. I think we may be lucky in that they got my good teeth. I didn't have a cavity until I was 27, nor did I have braces or any other treatment except sealants on my 12-year molars and then my wisdom teeth removed at 20. So if our kids are genetically predisposed to have teeth like mine, I'm good with that! (In the eye department, we're hoping they have their father's eyes. Nobody would want my almost-legally-blind glasses prescription.)

NJ and SB are both very good about brushing their teeth. Indeed, they seem to enjoy doing it. I certainly don't discourage them.

I was pleasantly surprised about how cooperative both kids were about getting their teeth cleaned and checked.  NJ had all sorts of questions about the equipment and displays and stuff in the room. The hygienist was amused and enjoyed it.

As for growing teeth, I have absolutely no advice as far as how to ease the pain or the transition. Every kid is different. Some kids barely notice teething, while others are terribly unhappy for a few days as a tooth erupts. Typically, once the tooth cuts through and you can feel it above the gum, the symptoms ease (until the next tooth). Remember, they need to get 16 teeth in the first two years, plus four more molars around two years of age. I'm so glad I don't remember being a baby!

I can tell you that it is absolutely possible to nurse a baby with teeth. If they are latched properly, you should not feel the teeth at all. Sometimes they have to learn to adjust their latch with the appearance of a new tooth, but the "retraining" shouldn't last more than a day or two. There is absolutely no merit to the myth that you have to stop breastfeeding when they get teeth. The only issue to be concerned about is biting. A teething baby might bite to relieve discomfort, or a baby with teeth might bite just to see what will happen. The best way to respond to a bite during nursing is to pop them off immediately (use your finger to break the suction and open the jaw first!), tell them "No bite!" firmly, and wait a minute before allowing them to come back to the breast. A baby needs to learn that biting is not acceptable behavior, and that biting will result in not nursing. If you yelp or otherwise make a funny noise (which you probably will do) but there is no consequence, the baby might think it's funny and bite again just to get the funny reaction. Fortunately, SB wasn't much of a biter, so I didn't have to worry about this too much. GI has bitten down a couple of times so far, but he doesn't have teeth yet, so it hurts, but it doesn't hurt. If you know what I mean.

Breastfeeding, incidentally (or topically) aids in the proper development of jaw and teeth, as well. The muscles and suction used in nursing pull the jaw and hard palate into the proper position and shape, reducing dental and orthodontic problems later in life. So you have that as yet another argument for breastfeeding, and continuing to breastfeed even after teeth erupt. Also, breastfeeding at night is not associated with a higher incidence of infant tooth decay. When a baby sleeps with a bottle in his mouth, milk/formula/juice can pool around the teeth, encouraging tooth decay and causing "bottle caries" in young infants. Breastfeeding at night, however, does not allow the pooling of milk around the teeth. In addition, breastmilk has antibacterial properties, so the breastmilk is actually killing the bacteria that lead to tooth decay. So you don't have to worry about that, either! Go ahead and keep on nursing your teething baby!

The only issue you may have to deal with in a teething baby is that some babies find nursing painful when they're teething. The pressure generated by nursing sometimes can compound the pressure of the teeth coming in, causing pain. Most babies will want to nurse more, as the counter-pressure is usually soothing, but some babies may reject the breast during the intense period just before a tooth comes in. Don't give up. Keep offering the breast, and possibly treat the pain with ibuprofen or Tylenol, and he'll come back to it when he gets hungry, or when the tooth comes in.

As far as my teeth go, they're in pretty good shape. Pregnancy and breastfeeding can weaken the mineral deposits in the mouth, causing thinning of the enamel and cavities. In addition, your immune system is typically depressed when pregnant and nursing, which means the oral flora can be affected as well, which can cause gingivitis and other periodontal problems. I seem to be fortunate in that I haven't seen too many ill effects. One thing I have noticed, though, is that I often clench my jaw when I'm nursing the baby, which is a very bad habit, and my teeth sometimes ache from that. I try to remember to relax my jaw and not tuck my chin down into my chest when I'm nursing.

And that's just about all I have to say about teeth right now.