Tizzie Hall is an international baby sleep expert who has been working with parents and their babies for over 15 years. Her specialist knowledge and routines have helped thousands of previously unsettled babies sleep the night and she's just released a new book in the UK called 'Save Our Sleep - Helping Your Baby To Sleep Through The Night From Birth To Two Years'.
Read on to discover Tizzie's fascinating story and some very useful tips to help you get your baby into a good sleep routine...
Graham: Could you just start off by telling us a little about your background and how you became interesting in parenting and helping parents to get their babies into good sleep routines?
Tizzie: I grew up in Ireland, where there are lots and lots of children around. When I was about seven years old, I had a baby brother, Richard, who unfortunately died of SIDS at about nine weeks old. From that moment, I went from house to house wanting to be the big sister to every baby that I could get my hands on to give a cuddle to.
I used to go from house to house looking after these babies and helping mums with them because of course, any mum with a child coming into their house entertaining their baby was happy for a child to do that, even though I was very young.
I think because of the fact that I had lost my baby brother, mums let me look after their babies more (when I say look after their babies, I mean the mums were there as well) because they felt sorry for me. Looking back on it, that’s how I think it all started.
I, on one occasion was taking a baby for a walk with the baby’s mum, and the mum said to me, “Oh, he’s crying. We’ve got to stop the pram.” I said, “Oh, no. That’s his going-to-sleep cry.” She looked at me and said, “No, nonsense, he’s not going to go to sleep; he’s really upset.” I said, “No, he’s not upset. He’s just fighting going to sleep. By the time we get to the green, he’ll be asleep.”
The green is a place where we grew up where we walked—it was a big play area for children, just trees and grass. My mum had taught me I wasn’t allowed to pick a baby up out of the pram until I got to the green for safety reasons. By the time we got there, this little boy was asleep.
So that’s where it all started, because a few nights later, his mum phoned our house in the middle of the night and said to my dad, “I need to talk to Tizzie.” He said, “What for?” She said, “The baby is crying and I need to know if it’s his going-to-sleep cry.” I was only about 13 at the time when I realized that I was able to help parents work out difernt cries.
Graham: That’s a fascinating story. Where do you think this ability to help with baby’s sleep patterns came from?
Tizzie: I think it came from two things: One, because I spent an awful lot of time with babies. I would be in a house with a six-week-old baby and then that baby might go to bed and the mum might say, “He’s gone to bed. Maybe you should go home,” and I’d just go to another house where there was another baby. That baby might be 18 months old.
So the 18-month-old baby would be using the odd word in its cry and especially by the time I was with two-year-olds, they would be using the odd word, so I’d be with a two-year-old, then six-week-old, then a nine-week-old, then a three-year-old, and I started to learn the rhythm, because all children’s cries are the same, but as they get older, they put words in. With a toddler, they’d be saying, “I don’t want to go to sleep. I don’t want to go to sleep.” I’d hear the baby doing the same cry.
Graham: They basically had the same behavior, pretty much—the same sort of cry, just saying they’re fighting the sleeping.
Tizzie: Exactly. Or, “I’m hungry,” or, “I’m cold,” but because I was moving from house to house with different age children, I quickly learnt to interpret the cries.
Graham: Right, so you really had a crash course in learning about babies’ sleep patterns as a child, which is amazing, really.
Tizzie: I did, and then I was fortunate enough to be able to travel throughout the years of my life, and I’ve been to countries like Mozambique, where babies are with their parents 24/7 and are tied to the parents. I developed my routines in watching these babies and watching what they do naturally.
It amazed me to see that every baby chose to drink at the same time, chose to sleep at the same time, and you’d ask these parents, “Are you following a routine?” They’d look at you as though, “No. I’m just doing what the baby is asking me to do.” They were all doing it at the same time, so that’s when I suddenly thought, “Bingo! Every baby can have the same routine.”
Graham: That’s fascinating. In Mozambique, the babies would naturally get themselves off to sleep at the right time, which is what, I presume, sometime around 7:00 in the evening?
Tizzie: Or during the day.
Graham:But they had very similar patterns of going to sleep at the same time?
Tizzie: Yes, so I was amazed by this. I sat there with pen and paper most all day and worked out what babies were doing at various ages, and that’s where I developed my routines from.
Graham:It seems to apply to any baby, regardless of their background or country.
Tizzie: It seemed to apply to any baby. Routines in the book are set by age, but ideally, they should be set by weight. It seems to change on the size of the baby, but that’s okay because there are lots of tips in the book to tell you how to adjust the routines as you go.
Graham: Your book, of course, is called Save Our Sleep and you’ve got a new edition coming out any time now?
Tizzie: It’s a new book coming out on the first of April in the United Kingdom. That book has been out in Australia for two years already, so a lot of people will already be familiar with the Australian edition, but now we’re having a UK edition.
Graham: I really look forward to seeing that. I’m sure it will be beneficial to a lot of people. Can you describe some of the main issues that affect and interrupt babies’ sleep patterns?
Tizzie: The main issues that affect babies’ sleep is that their needs aren’t being met, so they’re too hungry to sleep or they’re too cold to sleep or you’ve put them down to sleep somewhere and then you’ve moved them, so they wake up between sleep cycles and are unsure as to where they are. If we make sure that these factors are correct when we put them to bed—they’re full, they’re warm, and you’re putting them down to sleep where you intend for them to wake up to resettle to the next sleep cycle, they sleep fine.
Graham: Why do you think some babies get out of their sleep patterns? For parents, sometimes it’s difficult to know whether the baby is too warm or too cold. I know we’ve had that issue with our child, and it’s not always easy to tell, is it, whether it’s too hot or too cold?
Tizzie: I think it is easy to tell if you’re given the right pointers. Going back, babies, when they’re first born, can be rocked to sleep or fed to sleep, or will sleep even if they’re hungry or cold. It’s when they get to about eight weeks, their environment starts to affect how they sleep.
They start to sleep in daytime sleep cycles at eight weeks and they don’t start to sleep in nighttime sleep cycles until they’re about six months. So they start waking at night from about six months, which is often blamed on teething. If we make sure all these environmental factors are good, then you will have a good sleeper from day one.
You asked about if a baby is too hot or too cold. If a baby is too cold, they’ll catnap. If they’re old enough to roll, they will roll to their tummy and sleep in the on-face sleeping position of on their tummy. If they’re old enough to move and they’re too cold, they’ll move up the cot, jam their head against the cot side, put their bottom in the air, and put their hands underneath their tummy. If that baby is warm enough, he will sleep on his back in the same position and not move, which is safe.
Graham: Okay, so it’s actually a good indication if they’re moving about, turning if they’re getting cold or trying to move about to get warmer.
Tizzie: Yes, and if your baby is too warm, they’ll wake up every 20 minutes to half an hour and they’ll moan and there will be sweat dripping off them.
Graham: We certainly encountered that with our little boy on occasion, where he’s clearly been to warm.
Tizzie: The amazing thing is, lots of people use mattress protectors. They think they’re safe and they think they’re breathable because a lot of them say that they are, but they make the babies too warm. People contact me, we remove the mattress protector, add an extra blanket, and their child sleeps 12 hours.
Graham: Really? Okay.
Tizzie: It’s really that simple.
Graham: You wouldn’t think something like that could have such a profound effect, but that’s very interesting. What about other things like colic and reflux?
Tizzie: Reflux is, when a baby is born, their throat isn’t as developed as an adult’s, so it’s open and the reflux comes up from their tummy. So every baby has some form of reflux but some get more uncomfortable from reflux and have a much more severe case. If you feed your baby on a routine, the mum’s milk is thick and creamy so it refluxes less.
If you feed your baby on demand every couple of hours, the milk is very watery and it can reflux more. The feedback I get from mums whose babies are suffering from reflux is, when the follow a breastfeeding routine, which please note, is not [for only] from day one; that isn’t a safe routine for a breastfeeding mum, but if they follow a routine or they follow my routines, the reflux gets better because the milk is thicker.
Graham: I see. What about babies that catnap. How do you prevent very young babies from catnapping?
Tizzie: First of all, the difference between a catnap and a sleep, when I talk about catnapping, I’m talking about a nap. A nap is when a baby sleeps for 40 minutes or less, and a sleep is when a baby sleeps for 40 minutes or longer, so an hour or two hours. I try to encourage the babies on my routines to sleep for two hours.
Catnapping doesn’t normally start until a baby is about eight weeks old when they start to sleep in daytime sleep cycles. When a mum or dad come to me with catnapping, we look at a couple of things: One, often parents put their babies to bed when they first show a tired sign. When your baby first shows a tired sign, they could be tired enough to nap, but not tired enough to sleep. If we keep them up longer, it turns into a sleep.
Graham: Yes, I see.
Tizzie: Another problem is, babies are often too hungry to sleep well so depending on the age of the baby, if the baby were over 16 weeks and was catnapping, we’d look at introducing solids. If the baby were under 16 weeks, we’d look at things like: Is the mum on the mini-pill? Is the baby having a type of formula which isn’t filling them up enough?
We’d look at things that could be affecting their diet, why they’re not filling up. Often mums and dads will give their babies a set amount of formula or let them feed on the breast for a set amount of time. We shouldn’t restrict how much our baby is eating or drinking, and this can cause catnapping.
Graham: So you’ve got to be quite flexible on eating and just observing your child and whether they need more.
Tizzie: Also, if a baby is too cold, they’ll catnap and again, if you put them down to sleep and you move them, they’re going to catnap because they’re going to wake up and they’re going to be in a different environment. When we’re talking about feeing babies, we’ve got to remember that some babies will take 120 mills at one feed, but 180 mills at the next feed. It’s what they have on average in 24 hours; we don’t have to worry about what they have at each feed.
Graham: I see, so as long as they’re getting a certain amount each day.
Tizzie: Yes, and you’ll know if they’re getting the right amount because they’ll sleep well and be happy and contented.
Graham: What about babies that wake up early? I know that’s a problem that affects a lot of babies and can be difficult for parents. We’ve had that with our own child, waking up sometimes at half five or quarter to six. How do you address that?
Tizzie: It depends on the age of the baby. If the baby is very young, again, under 16 weeks, if they wake at half five, they could be hungry and you need to feed them. If your baby is slightly older and they’re waking up at that time, I would presume that they’re cold because that is the coldest time of the day and just by adding an extra cotton or bamboo blanket, your baby will sleep longer.
The other thing is, when a baby is older (so we’re talking about a toddler of about a year old), if they’re not eating enough protein and iron in their diet, they will wake up early. Also, if you introduce cow’s milk too early, they’ll wake up early.
Graham: Why does the lack of protein and iron cause them to wake up early?
Tizzie: I’m not a nutritionist so I can’t answer, but I can tell you it affects their sleep. It must be that they’re just not full enough to sleep all night. Again, children who eat custard wake up at 5:00 in the morning. We cut custard out of their diet and they sleep all night.
You have to remember, I don’t see the happy, sleeping children who eat custard and are fine, but I do have children who come to the sleep clinic who eat custard and wake at 5:00 in the morning. We remove the custard and they sleep fine.
Graham: It’s incredible that something like that can affect their sleep in that way. Tell us about baby formula and how that can affect a baby’s sleep pattern, Tizzie.
Tizzie: It amazes me that introducing something new to the diet can affect the sleep pattern. People often come to me with fully breastfed babies and they introduce some formula during the day, put the baby to bed at 7:00 at night and the baby wakes up at 7:40, screaming.
An interesting thing is, if we get the parent to introduce more formula…so let’s say they’re giving the baby 100 mills of formula and the baby wakes up at 7:40 screaming, if we increase it to 200 mills of formula, they sleep perfectly; or if we cut he formula out, they sleep perfectly.
But the same thing happens with a toddler when you introduce cow’s milk. Again, because I’m not a nutritionist and I’m not a medical person, I don’t understand why, but I can tell you it happens.
Graham: That’s interesting because you mentioned before about having a lack of protein and this is kind of the other way around. They’re having a certain amount of protein in the milk and that’s causing them to wake up within an hour of them going off.
Tizzie: It could be something else in the milk. It could be that there’s too much lactose. We don’t know what it is because as I said, I’m not a nutritionist, but it does affect them.
Graham: It’s weird that it could be a certain amount of milk that could wake them up, but if they have a bit more or it’s cut out completely, that can help them and they’ll sleep through.
Tizzie: Yes, and again, when we start solids, often we’ll see a baby become a bit unsettled. Parents often think, “Oh no, they’ve reacted to the solids,” and they cut the solids out. But if you actually increase the amount of solids you’re giving, the baby becomes happy and contented.
With the solids, I believe it’s something to do with, they’re introduced to some solids and the body thinks, “This is great. I want more of this,” and it’s like they’re demanding more solid food, but sometimes we misinterpret it and think that they’re intolerant to the food.
Graham: These are fascinating things you describe. I suppose diagnosing it for parents is the biggest challenge, isn’t it, to see exactly what the baby needs and what they’re trying to tell us by their crying. That’s the hard part, I guess, for a lot of parents.
Tizzie: It is the hard part. That’s where society has changed a lot, because we used to have our mums, grandmothers, sisters and aunts all living close by and helping us to interpret our baby’s cry. The feedback I’ve been getting from parents on my book which, as I said, has been out for a long time in other countries, is that the grandparents and mothers are saying, “This is exactly what we did with our children. It’s good, old common sense and it’s helping them to interpret their babies’ cries and their babies’ needs.”
Graham: Moving on to sleep positions—you touched on this earlier—babies moving around when they’re perhaps getting cold. What’s the best position for a baby to sleep in?
Tizzie: It’s a very interesting topic because the best, the safest sleep position for a baby to sleep in is on their back. Since we’ve been educated about cot death and SIDS and told to sleep our babies on their back, the rate of cot death and SIDS has dropped considerably.
Often, you hear of people saying, “I put my baby to sleep on his tummy and he sleeps much, much better. Why would I put him on his back when he wakes up all night?” But I believe he’s waking up all night because he’s cold.
If you put that tummy sleeper on their back, but add extra cotton or bamboo blankets, making sure that their face and head are uncovered, they sleep perfectly. It’s very important to sleep them on their back and to put nothing in their cot. People often sleep babies in their sides and add sleep positioners, et cetera, and that’s dangerous.
Graham: Even the baby turning onto the side is dangerous.
Tizzie: It’s dangerous. I have observed that if your baby is warm enough and wrapped correctly, they will sleep perfectly on their back in the same position and not move, and I’m talking about babies up to 18 months.
Graham: Beyond 18 months, can cot death still occur?
Tizzie: Beyond 18 months, cot death can still occur and it does still occur and it’s terribly, terribly sad, but a baby is old enough to move around their cot and it seems to be more difficult to keep them safely on their back.
Graham: Are they at the same risk of cot death?
Tizzie: Cot death is most common in babies around eight weeks old, so they’re at less risk, but it does still happen.
Graham: What about routines for the baby? Parents often struggle to establish a routine for one reason or another. Obviously they have busy work lives or life gets in the way and the baby doesn’t always get into a settled routine. Any tips on that?
Tizzie: A routine is very easy because even if you’re out and about or busy, you can still have a routine. I’ve just traveled from the other side of the world to here with my very small children. I have a five-month-old and a two-year-old, and we are able to follow the routine even when we’re going to meetings, because we just make sure, at their sleep time, that they’re somewhere safe and able to sleep. You just need to make sure that you’re able to feed them at their feed time.
Graham: Yes, just plan accordingly.
Tizzie: Exactly. For years, health professionals have debated whether to use routines or not and it’s always said children feel safe and secure when in a routine. Routines don’t have to be that scary because as I said, you can follow a routine even if you have a busy life. It’s easier to follow a routine and have a busy life than not follow a routine. Then you just don’t know whether you’re coming or going.
Graham: That’s right! That’s very true. What do you recommend to dress a baby in for sleep time in terms of comfort and aiding their sleep?
Tizzie: It depends on where you are as to what to dress your baby in. It’s very difficult to say, “This is what you need to dress your baby in,” because there are lots of factors. Is the house heated? Is there humidity? Is it summer? Is it winter? In what part of the world are you living?
For example, 20 degrees in Dublin is really, really warm. Twenty degrees in Victoria, Australia is really, really cold. I have been in London when it’s 20 degrees, then I’ve got on a plane and gone to Australia where it’s 20 degrees and I’m freezing and wearing a coat. Yet in London, I’m wearing a t-shirt. So it depends on the humidity, et cetera. I give guides as to what to dress your baby in.
I suggest that a baby’s room is heated in winter to 20 degrees and no warmer and that they wear a body suit, a babygro. If they’re under eight weeks, a wrap; if they’re over eight weeks, a safe sleeping bag and then a wrap over it, plus sheets and cotton blankets, depending on the temperature in the room. But if it’s 20 degrees, roughly four cotton blankets.
Graham: So 20 degrees during the winter.
Tizzie: And I’m saying during the winter, for example, in London. It would depend on where you are and what the humidity levels were.
Graham: So the humidity is obviously a big factor as well.
Tizzie: Yes.
Graham: If you are in a very humid environment, if it’s the middle of the summer in Britain, it can get particularly humid. How would you dress the baby then?
Tizzie: You would look at the temperature and the humidity as well. It’s very difficult to tell—we don’t all have a thermometer in our house to tell us what the humidity is—but you’ve got to watch your baby. If your baby tries to roll to their tummy or starts catnapping, then add an extra blanket.
If they’re waking up moaning and sweating and there is sweat pouring off them, then they’re too hot and you need to take a blanket off. So it’s about watching your baby and learning their signs. It’s dangerous to overheat a baby, but you have to get it really wrong to overheat them.
The degrees or the humidity going up a tiny bit is not going to suddenly overheat a baby, but leaving them in a car in the sun or putting them to sleep in front of the gas fire is going to overheat them. A hat on inside or a hat on at sleep time will cause them to overheat. It’s very important that they have their face and head uncovered when they’re sleeping.
Graham: Thank you, Tizzie. It’s been fascinating talking to you. I’ve learned a lot—things I didn’t realize at all—and I’m sure people listening to or reading this interview will find it very interesting. Your book coming out on April the first is called Save Our Sleep—Helping your baby to sleep through the night from birth to two years. It’s available on Amazon, and also on your website, which is www.SaveOurSleep.com.
