Comments on: A Holistic Approach to Baby and Toddler Sleep (with Grace Koinange)

By: Suzanne Crooks

Suzanne Crooks — Mon, 08 Aug 2022 19:41:12 +0000

I love the podcast and listen regularly from the UK but went to specifically to check Grace’s qualifications and background because I was very surprised by a lot of what she was saying and recommending in terms of infant sleep. Didn’t seem to fit with a neurobiological understanding of infant sleep and wasn’t back up by any strong theory or research other than personal experience and other sleep training approaches. Overall disappointed that there was not more questions asked or critique of some of this information, particularly the advice in regards to nutrition which is noted above in the other comments.

By: Dr Hayley Glasson

Dr Hayley Glasson — Tue, 05 Jul 2022 01:53:40 +0000

Whilst I’m a big fan, I was also quite disappointed with this episode, and felt that it runs counter to the Janet Lansbury philosophy of trusting in your baby.

I highly recommend having a look at Dr Pamela Douglas’ work at Milk and Moon Babies http://milkndmoonbabies.com/ The program is completely evidence based, up to date and is very much about supporting parents in nurturing their bubs based on their individual needs, values and goals. Perhaps Pamela would be a great guest to have on the show, to counter many of the breastfeeding and sleep myths that abound in this space.

By: Jade

Jade — Tue, 10 May 2022 18:58:06 +0000

In reply to Jessica Isles.

This was also very strange to me – and contradictory to advice given on another podcast to ‘trust’ that children know their nutrition needs.

Also my baby spent her life at the breast till around 4 months and gained weight like nobody’s business, was unhappy doing anything else and slept and napped terribly (unless next to or on me). I’m pretty sure each infant’s calorific needs (and mother’s breast milk composition) will vary as we all vary!

I think the advice in this podcast largely ignores (some) infants’ needs for near-physical proximity to a care giver and the fact that breast milk adapts itself to a baby’s needs. I can tell you now, I would have been extremely triggered as a mum overwhelmed by near-constant breastfeeding to be told maybe my baby’s sleep issues were around her not getting enough!

By: Mary Harris

Mary Harris — Wed, 26 Jan 2022 19:50:37 +0000

Hello Janet,

I am a huge fan of yours. Listening to your podcasts has helped me with my (now) 4 children! I am also a physician (for adults) and felt very strongly about writing you after listening to this podcast. I was so surprised to hear what Grace Koinange had to say about the 2.5month old breast fed baby who wakes up after 20 minutes after placed in a crib. Her response implies – wrongly so – that (breastfed) babies have short naps because they are hungry. Furthermore, the calculation of how much breastmilk a baby should take (double the weight in pounds) was also completely wrong. For decades, mothers have been told that they are not giving their baby enough breastmilk! Please do not add to this misinformation and potentially destroy an already very delicate relationship! I would suggest deleting this segment from your podcast. It is confusing and adds to what is already mountains of misinformation about breastfeeding . I would also suggest perhaps having a true breastfeeding expert/well-practiced lactation consultant comment about infant sleep and breastfeeding if at all possible. Per kellymom.com, breastfed babies can take 19-30 oz breastmilk /24 hours. It is my understanding that this amount does not necessarily increase over time. https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/

Also note that at 2.5 months, babies still have the moro reflex. This baby’s arms are out, so perhaps suggesting a swaddle that allows the baby’s arms to be up but that also suppresses the moro reflex might be helpful.

By: Jessica Isles

Jessica Isles — Wed, 22 Dec 2021 04:03:41 +0000

In reply to Steph. Agree 100%. Thank you for posting!

By: Jessica Isles

Jessica Isles — Wed, 22 Dec 2021 04:02:07 +0000

All so interesting to read and I’m sure letting our kiddos play with less adult input and help can aid sleep. However, sleep training is associated with lowering mama’s milk supply and often seen as the end of a plentiful milk supply. Sleep looks very different for the formula fed baby vs the breastfed baby at the breast (vs pumping and feeding by bottle). The reason for this is that the less a baby feeds at the breast the less milk mama makes. A baby sleeping through the night ie 7-7 for example with no pumping will result in mama making less and less milk and within a few days her supply will reduce and before long she will have to supplement and then it generally results in the end of the breastfeeding journey.
I do feel it’s important for mother’s to know that a newborn feeding every hour (sometimes it feels almost continuous) is quite normal. Human beings are a ‘contact species’ which means a newborn’s heart rate, breathing, body temperature etc is regulated by the adult. This is why they fall asleep peacefully at the breast – isn’t that perfect!! Let’s embrace that rather than fighting it.
Another important fact is that because the storage capacity of each woman’s breast is different and the size of each baby’s stomach is different the number of times and the length of a feed varies widely. The best way to accept this and ensure a plentiful milk supply is to throw away the clock and read baby’s cues! Afterall, clocks are modern inventions and babies thrived well before the advent of any technology 🙂
Re quantities of milk, each baby differs in how much milk they want and need at each feed and that amount is completely different from feed to feed and depending on breast or formula. These are completely different substances with virtually nothing in common. In addition, breast milk can be fattier or more watery from feed to feed so that will mean that only baby will know when they need more or less and they need to be listened to! Also, if it’s hot weather, a baby will often drink more from the breast. Trying to decide for the baby how much they need takes away their agency – they know exactly how much to eat and how often to suckle in order to maintain perfect health – we must honor that. We do not know best and nor does the clock! Letting a baby fall asleep at the breast ensures adequate milk intake and adequate stimulation of the breast to make just the right amount of milk.
Breastsleeping, as described and researched by Dr James McKenna, is the ideal and species appropriate way to feed our young. We sleep and they sleep and feed throughout the night. The benefits of breastfeeding for mother and baby are dependent on frequency and duration. For mother infant couples with no risk factors such as smoking, obesity, substance abuse etc breastsleeping is the most protective way to sleep with our young.
Please also note that babies most often die alone. This is why sleeping in the same room as your baby is recommended for the first year of life. In addition, the use of formula is associated with a higher risk of SIDS. So, the last thing we want to do by sleep training is cut short a breastfeeding journey.
Mothering can be so simple, just be with baby and put them to the breast often. Let them sleep where ever and when ever they feel happiest whether in your arms, on your breast or in a stroller. It doesn’t matter as long as they have access to comfort and the breast whenever they need it. It is a need.
And lastly, doesn’t anyone else wonder how it feels to a child to see his parents cuddled up together while he/she has to sleep alone? Shouldn’t we lead by example and have Mama and Papa in separate rooms. If we expect a child to sleep alone we can at least start by showing them how it’s done? I think that’s only fair. If that doesn’t appeal just cuddle up together in a family sized bed!

By: Steph

Steph — Mon, 20 Dec 2021 01:18:05 +0000

TLDR: Calculating required breastmilk volume by weight in infants older than 1month is NOT evidence based – response from a doctor

Hi Janet,

I love your work and your perspective – I was fortunate to read your book – Elevating child care – when I was pregnant and I have had such an amazing journey delighting in my daughter since she was born because of your advice. She is skilled in independent play (and so many other things) because you taught me to be an interested observer and I enjoyed hearing your talk with Grace Koinange – how true that sleep is about what happens through the day.

I wanted to address the advice Grace gave in your podcast regarding calculating breastmilk intake by weight – I am a doctor and in my medical opinion the advice she gave is not evidence based. Formula intake is generally calculated by weight because cow’s milk formula and other breastmilk-substitutes are metabolised differently than breastmilk. Research has shown that breastmilk intake varies between babies but is relatively stable regardless of weight in an individual baby from age 1 month to 6 months (generally between 750-900ml / ~25-30oz in 24hrs) and then after 6 months decreases with the introduction of solid foods. This is important as telling women otherwise may lead to:
-loss of confidence in their supply (and often related loss of confidence in themselves),
-anxiety related to normal fluctuations in weight and/or inaccurate scales (scales need to be accurate to 2g in order to make use of the weigh pre and post feeds Grace described),
-adding pumping and bottled breastmilk top ups and or formula top ups which can add to parents’ workload; can make it harder for babies to self regulate their milk intake; and can lead to bottle preference and unplanned early cessation of breastfeeding.

The parent’s question that you asked Grace I wouldn’t confidently answer without more information but besides being hungry the mother did say her baby sleeps a lot and it did sound like the baby could have had low sleep pressure at night and was being put to sleep when they weren’t tired enough and so contact naps could be maintained but as soon as the baby was put down that low sleep pressure led to them easily waking. Each baby has unique sleep needs and some just don’t need as much sleep over a 24hr period as others, if baby isn’t sleeping well at night they may be spending too much time napping during the day.

Please see this link to an article discussing normal milk intake patterns in babies if you are interested. https://dhss.delaware.gov/dhss/dph/chs/files/resmohrbachermagicnumber2011.pdf