Friday, September 30, 2011

Bedtime Routines

So in earlier sleep posts I mentioned the importance of schedule and routine for developing good sleep hygiene.  This actually goes for adults as well.  

Over the years our "routine" has changed here or there. The overall structure is the same and we do try to keep the times consistent.  I figure I'd outline our current routine as a memoir for later years...

Currently, hubby is on a business trip.  I do have my au pair around but I usually give her the weekends off.  So here's a typical night when it is just me putting all 3 to bed:

6pm - Dinner time!  ...or  "mum mum time" as my #2 likes to call it...

I march the two girls to the bathroom to wash their hands why bjorning my third.  If he is not fussing, I'd put him on a bouncy seat in the kitchen.  

Next... strapping down both kids on booster seats is key to keep them from running around and gives me more control.  Yep.. I even strap my preschooler... (though more recently I've allowed her to sit in a grown up chair but it depends on my mood and how much control I need at the moment)

Now I rummage through our fridge and usually there is enough leftovers for me to scrounge up dinner for the two as well as for myself.  (This is when I'm completely alone and don't feel like cooking at all).

While they are "eating"... I now can take #3 upstairs for his bath.

Putting down my 3 month old...
Depending on the night he can be either very easy or very hard.  Usually after I bathe him, I dress him in a onesie.  Right now I find he still sleeps better swaddled so his hands cannot flail all over the place.  I feed him and he usually gets pretty sleepy towards the end.  Sometimes I'd give a bottle of pumped milk instead of nursing so I know exactly how much he drinks.  Once sleepy, I either put in bed propped a little sideways or I put him on the swing with a pacifier... it depends on how fussy he is.  Eventually, we'll sleep train him so he'll be in his crib every night.  But right now, I'm still in survival mode... 

6:30pm - Finish up dinner...

I go back to examine the mess.  Usually what I'd find is #1 would have hardly touched her food and is distracted with some book or toy or other that she found on our messy kitchen table.  #2 has food all over her mouth, hair, hands. floor, wall etc. but usually does a pretty good job of eating what's given to her.

So I'd wolf down my own dinner while throwing food on the tray for my #2 and coaching my #1 to "take another bite"...  "take another bite and I'll answer that question"... "take another bite and I'll read the next page.."  Like other preschoolers her age, she is not a very good eater and often a source of great frustration.  Will blog more on picky eating in another post...

7pm - Bath time for #2

Usually at this point, #1 is just about done.  On a good day if she is done, I can give her an ice pop or ice cream (we're actually trying to fatten this one up)!  This keeps her busy and happy while I take #2 upstairs...  Sometimes I throw in a video as well although more recently I haven't had to and she just entertains herself somehow.

Putting down my 22 month old...
By far, she is my easiest child to put down.  She goes on the potty before her bath and actually has been going pretty consistently for the past month.  I bathe her and get her into her pj's.  We are still using a sleep sack with her so I put that over her pj's.  Next we go downstairs to grab a bottle of warmed up milk which she drinks while I read a few books to her.  She would keep pointing and wanting me to read more but depending on the time, I'd usually only read 1 or 2.  She actually really likes to just go through her ABC book and point and say all the pictures on there including the letters.  Right now she recognizes just about all 26 letters.  Here are some favorite bedtime stories we've been reading recently:
The Going to Bed Book
Goodnight, Goodnight, Sleepyhead
Good Morning, Good Night!

Other favorites and classics:
Goodnight Moon
Goodnight Gorilla
Shhhh!  Everybody's Sleeping

Reading is actually my favorite part of the whole bedtime routine.  Now, we put the bottle away.  Go to the bathroom to brush her teeth.  Then I shut out the lights.  Turn on the sound machine.  She has recently wanted me to sing "Jesus Loves Me" to her while holding her.  I love this part and often want to just hold and rock her.  Often I prolong it by singing the song twice or humming it a third time.  Finally, I ask her if she is ready for her "yellow blanket" and "wawa" (means doll in chinese).  She usually responds with "ya".  I lay her in her crib and giver her her blanket in one arm and doll in the other.  Then I tell her I love her and blow her a kiss.  She blows me a kiss back.  Then I leave and shut the door behind me and she is down for the rest of the night!

7:30pm - Bath time for #1
Getting her upstairs is tricky because she often will want to "just play a little more".  Lately, we've pulled out our kitchen timer to use in various scenarios.  Here is one where I'd set it to five minutes and tell her that once it beeps, we have to go upstairs.  While she is playing, I can then clean up the kitchen mess.  So if we do this right, there is no meltdown and fussing.  Otherwise, we get some stomping and crumpling to the floor bawling but since we've implemented the timer, things have been going more smoothly.

Putting down my almost 4 year old...
So by far, she is my hardest kid... ever since birth.  I start off by asking her to pinky promise me that she will not fuss later when I put her to bed.  This was a recent thing I started after having many difficult nights with her... and now has become a part of her bedtime routine.  We hook pinkies and shake.  Then I remind her to "sneak" when we go upstairs.  Otherwise, her loud stomping and talking would wake #2 up and cause a lot of crying.

I usher her into the bathroom as quickily as possible and shut the door.  If we turn on the hallway light or have the bathroom door wide open when the lights are on, #2 can see the light from her crib and will often cry.

While on the potty I ask her what she wants to wear to sleep (for if I choose the wrong outfit, we'd have another meltdown).  I get her clothes and help bathe her.  Changing into the nightwear, blow drying her hair, then brushing her teeth usually goes fairly smoothly but takes some prompting.  We get into her room and switch on the sound machine.  Maybe it is a false sense of security, but I hope it drowns out noise so to not wake or bother #2.

Now my preschooler picks out the clothes she wants to wear the next day (this helps the morning run smoother).  This process often takes some negotiating because sometimes the clothes she picks is just not practical for the weather.  I tell myself I need to clean out her closet and only have appropriate clothes out as a choice but have not found the time to do so yet.

Then it is time to get in bed and read a story!  Lately she has been picking a chapter from her chldren's Bible book.  It is short and simple and has a memory verse at the end.  At this point, I can turn on the night light and turn off her regular lights.

Now the tricky part is "tucking her in" correctly.  99% of our bedtime melt downs happen at this step.  I often get it wrong because she wants the blankets in a particular order and tucked under her in a certain way but needs to be tucked under the pillows too.  Whew!  She is also holding her baby doll who I have to help her swaddle in a blanket and have the doll's bottle and a toy cinderella cell phone by her side.  Little donut pillow also by her side for her baby doll to sometimes sleep on.  Can you tell that this daughter of mine is very particular?

Finally, with her all tucked in and with only the nightlight on, I get to make up a "princess story".  Sometimes I tell her about the "blue princess who likes to have everything blue"... or the "princess who talks too much"...  I just make up whatever comes to my mind and she is usually fairly entertained.  However, I always have to start with "once upon a time... " and I have to end with "the end".

Then prayer time...  The past few nights, she has asked me what my "prayer request" is.  I'd pray for her and she'd pray for me and we'd pray for whoever else comes to mind or needs prayer that day.  Her typical prayer these nights... 

"Dear Lord, please help E not cry so mommy can sleep."  or  "Dear Lord, please help me be good so mommy doesn't get mad".

Then... I sing her a song.  Sometimes she lets me pick but usually she has a song in mind.  Tonight it was the Awana Cubbies theme song.

Finally... I walk over to her ipod machine and turn on the music with 30min to "sleep".  Every night she listens to Hide 'Em in Your Heart and wants me to start with the song, When I Am Afraid.  Once the music starts, she wants me to "run out fast" but I have to "leave the door a little open".

I usually heave a huge sigh of relief if I get out of there with no crying/fussing/meltdown!   Depending on whether she napped that day, she will either pass out fairly soon... or more often she'd talk and sing to herself for sometimes a couple of hours before finally falling asleep.  Either way, I usually do not have to go back in the room once I leave her room.

Therefore most nights at around 830pm or 9pm I'm done and have time to myself!  Yay!  This is when I pull out my laptop and get a few emails in... or blog... or get caught reading random things on facebook...  when I really should be sleeping because #3 will probably wake up any minute now to feed!

So... goodnight...

Wednesday, September 28, 2011

Baby Constipation

Kid #3 is exactly 3 months old today!  We're planning on celebrating his 100 day birthday korean style.  Grandma C is coming to meet him for the first time and to plan the party.  Being chinese, I'm not that familiar with the korean traditions but one common theme across most asian cultures in general is that it involves food.

So this kid has been pooping every 4-7 days.  Constipation you say?  Well, actually for babies constipation is determined more by the consistency of the stool and not so much by the frequency.  Some breastfed babies can go 8-10 days without a bm because breastmilk is absorbed better than formula.  Formula fed babies usually go at least once a day.  As primary care physicians, we get calls all the time from distraught moms worried that their baby is constipated.  Depending on age and circumstance, sometimes a glycerin suppository is warranted... or the good 'ole rectal stimulation with a thermometer... but probably more times than not, baby is fine and not really constipated.

Common causes of constipation would be:
  • switching from breastmilk to formula
  • recently starting on solids
It is rare that mom's diet will actually affect baby to be constipated.  However, if getting the sense that certain foods make baby more fussy or break out in rashes... then common foods to avoid include:
  • milk (lactose) products
  • soy
  • wheat
  • corn
  • eggs
  • peanuts

So if you think baby is truly constipated, call your physician.  However, if baby seems fairly happy, not straining to poop, and poop is not really hard... then the timing may just be a variant of normal.  

Ofcourse it is always harder when it is your own kid.  After day 4 or 5 of no poop... there is usually much rejoicing when we get a stinky poopey diaper!

Monday, September 26, 2011

About Work and Sleep...

Here we go... the start of another week!

Last week, my boss came back from vacation so my hours went back to normal (which is about 25 hrs/week).  Kudos to you full time working moms!  I would totally burn out in less than one month if I had to work full-time.  I'm not sure about other jobs but as a family doc I feel like I'm trying to meet everyone's needs.  So when I was working extra shifts I felt like I was non-stop trying to meet need after need after need...  Even after work, my phone would ring and I'm pulled to give sound advice... call in scripts... all this with screaming children in the background.  The lack of sleep at night does not help things either.

So... with back to normal hours I feel better.  Now if I can only get E to sleep longer at night.. all I ask is a consistent 3 hr stretches... soon it will be time to sleep train...

It is funny when I read my previous posts about training my child #2.  She sleeps great ever since... 7p-7a!!  I truly believe that if we didn't try to train her, she'd still be waking up crying in the middle of the night or crawling in bed with us.  Child #1, too!!

So first child slept through the night at 15 months... second child at 12 months.. I'm hoping with this third child he'll be sleeping through by 6!  We'll see...

Monday, September 19, 2011

Clone Me!

So I've been thinking about this for some time now... need to make a sci fi movie about mommies who clone themselves in order to manage their households as well as hold jobs and find time to relax etc all at the same time!

I really longed for a clone while on our mini-vacation trip during Labor Day weekend.  Husband and au pair were both with me on this trip so adult child ratio was one to one.  Nevertheless, there were moments where I wished I could have been in 3 places at once!  Here is an example:

We all just got back from dinner and now is the time to get the kids down for the night.  We have been giving E a bottle of breastmilk before his sleep at night so we know exactly how much he drinks hoping this would help him sleep longer.  So daddy had that job.  Au pair was going to try to bathe both girls at the same time.  I had to pump, wash the pump stuff, then store the milk.  While pumping I can hear all the commotion going on outside my bedroom door.  E was crying very hard and having a hard time drinking his bottle for whatever reason.  The two girls were squealing and excited that they were going to sleep in the same room that night.  I went over to help hold E who quieted down right away.  Meanwhile, my milk is sitting out because I didn't get to put it away yet.. so I direct husband to go put it away for me.  Then I hear the girls acting out... S is screaming something and starting to have an attitude.  So when our au pair comes out of their room, I hand her E and go into the girls' room to assess the situation and calm them down.  

It is fuzzy in my memory now, but I think I went back and forth between baby and my girls for a while before baby finally passed out on the sofa bed.  I had to lay in the room with the girls until they fell asleep to keep them from talking and keeping each other up.  I actually didn't mind that part because I probably fell asleep before either of them did.

So yes, having other caregivers around is definitely more helpful than being alone by myself... but sometimes I feel like cloning myself would be the easiest and most efficient way to get all that needs to be done done!  Then I need that extra clone to just sleep for me.

Now that I think about it, this post is similar to another post I wrote about a year and a half ago!

Boy, I should be sleeping now... but one last thing...  I found this on the web while googling "mommy clones".  Heh.  This is a better for Christmas time but since on the subject I'll post it now.

So for all the moms out there... 

'Twas the night before Christmas, when all through the abode
Only one creature was stirring, and she was cleaning the commode.
The children were finally sleeping all snug in their beds,
while visions of Nintendo and Barbie flipped through their heads.
The dad was snoring in front of the TV,
With a half-constructed bicycle propped on his knee.
So only Mom heard the reindeer hooves clatter,
Which made her sigh, "Now what is the matter?"
With the toilet bowl brush still clutched in her hand,
She descended the stairs and saw the old man.
He was covered with ashes and soot, which fell with a shrug,
"Oh, great," muttered Mom, "now I have to clean the rug."
"Ho Ho Ho!" cried Santa, "I'm glad you're awake,
your gift was especially difficult to make."
"Thanks, Santa, but all I want is time alone."
"Exactly!" he chuckled, "So, I've made you a clone."
"A clone?" she muttered, "What good is that?"
"Run along, Santa, I've no time for chit chat."
Then out walked the clone - The Mother's twin;
Same hair, same eyes, same double chin.
"She'll cook, she'll dust, she'll mop every mess.
You'll relax, take it easy, watch The Young and The Restless."
"Fantastic!" the Mom cheered. "My dream has come true!"
"I'll shop, I'll read, I'll sleep a night through!"
From the room above, the youngest did fret.
"Mommy? Come quickly, I'm scared and I'm wet."
The clone replied, "I'm coming, sweetheart."
"Hey," the Mom smiled, "she sure knows her part."
The clone changed the small one and hummed her a tune,
as she bundled the child in a blanket cocoon.
"You're the best mommy ever.  I really love you."
The clone smiled and sighed, "And I love you, too."
The Mom frowned and said, "Sorry, Santa, no deal.
That's my child's love she is trying to steal."
Smiling wisely, Santa said, "To me it is clear,
Only one loving Mother is needed here."
The Mom kissed her child and tucked her in bed.
"Thank you, Santa, for clearing my head.
I sometimes forget, it won't be very long,
when they'll be too old for my cradle and song."
The clock on the mantle began to chime.
Santa whispered to the clone, "It works every time."
With the clone by his side, Santa said, "Good night.
Merry Christmas, dear Mom, you will be all right."
~ Author Unknown ~

So maybe I don't want a clone after all... but just  a little sleep would be nice.  G'night!

Monday, September 12, 2011

Head Injuries

It has been a crazy two weeks since my boss is on vacation and I'm working more than my usual number of shifts.  Today I come home for a lunch break and was about to sit down for some nourishment when I hear a loud BANG.  I look over and my preschooler and her chair are tipped over on the ground.  She probably kicked the table with her legs despite the many times we've warned her not to... and this time her chair tipped.  I rushed over to assess the situation.

No blood.  Not much swelling.  However, I did have a loudly crying child who was terribly shaken up.  I coax her to calm down as I move her to the refrigerator so I can grab some ice.  I also couldn't help but started lecturing her on how this is why she should obey when we tell her not to do things... how mommies and daddies are always looking out for her best interest... and how she should never disobey anything we say ever again!

My dad was helping me babysit today and he is a pretty anxious person on a good day.  So the loud commotion drew him to the scene in a panic.  The string of nervous comments that followed only heightened the situation and caused my child to cry louder and start coughing.  Once the coughing started, I knew what was going to come... all her lunch.  She threw up and threw up... got it all over the floor, herself, and my skirt.  When we thought she was done, she threw up some more.  During these moments, I never know whether to move her to the bathroom or just stay put.  We stayed put.  I figured a puddle of throw up was easier to clean than a long trail.  Finally, things did settle down.  S got a bath and I changed into scrubs.  I still needed to get back to work but thankfully (though unusual for Monday) the schedule was lighter and I was able to stay home to monitor S a little longer.

So when do you take a child to the ER after a head injury?  And when do you need a CT scan after a head injury?

Well, when in doubt, never hesitate to call your physician and ask.  But here are some general guidelines...

Get your child evaluated after any head injury but you can call to determine whether that means bringing him or her into the primary care office or going straight to the ER.  Physicians are not as quick to get a head CT on a child anymore due to the high exposure of radiation.  In a developing body, they are more prone to long term risks such as cancer.  So there was a study of 40,000 children treated for head trauma in 25 emergency room centers between 2004 and 2006.  They found that 4 to 6 hours of observation reduced the amount of CT scans ordered with comparable outcomes as those who ordered ct scans right away.

So some signs that would have caused me to take my preschooler to the ER today for a head ct include:
  • if her vomiting recurred or did not resolve
  • if she became confused
  • if she had slurred speech or started to say things that did not make sense
  • if she had any visual complaints
  • if she had any difficulty with balance or her coordination
  • if she continued to fuss and cry and be irritable

Monday, September 5, 2011

Mini Beach Trip with the Kids

We just returned from going out to Ortley Beach near Seaside Heights, NJ.  This is the first time we are hittng the beach all summer because of new baby.  Well, I'm too tired to write a long post but here are few thoughts that swam in my head all weekend... I'll expound later...

  •  "I wish I can clone myself and just be at 3 places at once!"
  •  "Ugh... never never try to take a close up picture without zoom of a toddler playing with sand"
  •  "Hmmm... maybe sticking both girls in the same room was a bad idea after all..."
  •  "Wish I can just stop time and lay here listening to the crashing waves..."

Thursday, September 1, 2011

Hurricane Irene

My thoughts go out to all those who were affected by Hurricane Irene... and who are still dealing with the consequences.  

Fortunately, for us, we were minimally affected.  We sure did get a ton of wind and rain.  I remember looking out the window and feeling thankful for shelter.  

On Sunday, church was cancelled and our power went out for about twelve hours.  My husband got to experience some of the stress and chaos of feeding and entertaining three young children under the age of four.  Maybe if we weren't both so sleep deprived from getting up so often for E (our youngest who actually just hit two months that day) we would have more brain power to be creative or have more energy to play with our kids.  Instead,  picture this...  A (my middle child) is running around full of energy and getting into her older sister's things... which of course causes much protest!  I forget what E was doing but maybe husband was bouncing him on his knee while laying on the ground of the basement floor.  I am laying on the ground not too far from him and decide to pretend to be in a hair salon.  I ask S to come wash my hair to see if that will distract her from A.  My husband liked the idea and asked her to go over and wash his hair afterwards.  That lasted about five minutes.  We were trying to find every excuse to stay horizontal and expend as little energy as possible.

I found it nice that we did not have tv or internet to distract us... However, nap time which is usually about 3 hours of adult sanctuary, was cut short.  Why?  Well, no power meant no AC and it was pretty hot that day.  Plus, we could not turn on the sound machines in both girls bedrooms which we seem to think makes a difference.

So overall, it was a nice family day... didn't do much but sometimes it is nice to just be together in one place not doing much...