International Travel with Kids: 10 Lessons Learned

By Sarah Ruttan

In yesterday’s post, I talked about the highs and lows of traveling abroad with young kids. While we’re not planning any international trips in the near future, we definitely learned some important lessons on this trip that we’ll take into account when planning future travel. Some of this advice relates to any type of travel with children, but there are special considerations when traveling out of the country.

1. Travel light. We didn’t bring a stroller, opting instead for our trusty Ergo. I almost felt naked getting onto the plane, yet also slightly liberated. The cobble stone streets of colonial Peru wouldn’t have made a stroller any fun, anyway. Depending on your destination, mode of travel, and itinerary, you may be able to leave car seats behind, or rent them for any car rides you’ll take. We planned our trip so that we were primarily traveling by plane or boat and made do without car seats for the short taxi ride from the airport. (Once there, we also found that most taxis didn’t have seat belts or clips, so we wouldn’t have been able to use car seats had we brought them.) We strategically packed a few clothing items that both kids were about to outgrow so that we could leave the clothes and have room for a few souvenirs on the return trip. [This paragraph was edited after posting to emphasize that the car seat decision is really dependent on where you’re traveling and how you plan your trip. It isn’t one to be taken lightly, and Sarah and her husband carefully considered their options before deciding not to bring them. ~Alice]

A word about diapers: We only had one child in diapers and brought just enough with us to last until we knew would be in a city where we could buy more (4 days worth). Diapers are bulky to pack and widely available in most cities, so only bring what you absolutely need.

Photo by Sarah Ruttan.

Photo by Sarah Ruttan.

2. Think about time zones. Sometimes you can’t choose where you travel, but when you do have a choice, consider how many time zones you want to cross with young kids. Jet lag can be brutal for adults, and it’s worse with toddlers who often take several (painful) days to adjust. We didn’t choose Peru because of time zones, but it was definitely a nice perk to only contend with a one-hour adjustment. We’ll likely save crossing the Atlantic or Pacific until our kids are a bit older and able to entertain themselves once we’re home and I want to sleep!

3. Choose an itinerary that will work for your kids at whatever stage they’re in. Continue reading

Introducing Our New Baby Boy!

I think it’s time to officially introduce you to our new baby! If you follow me on Facebook, you know that our baby boy was born just before Christmas, and if you’re not on Facebook, you’ve probably guessed as much. Here on the blog, I’ll call him BabyM until I come up with a better blog name. (I have the foresight to realize that BabyM won’t be an appropriate name forever, and nor will the other things I call him now, like Milk Man, Sweet Cheeks, or Little Guy. I’m already terrified of how quickly he will grow!)

BabyM’s birthday went well. I started having contractions at midnight, went to the hospital around 4:30 AM, and we had our healthy baby boy just after 9 AM. My labor with Cee lasted 30 hours, and although I don’t think I would do anything differently if I could, it was a marathon that included an epidural, Pitocin, and more than two hours of pushing. BabyM, on the other hand, came so fast that by the time the pain got really intense, there wasn’t time to think about an epidural. I didn’t have my heart set on anything about this labor and delivery – after wanting this baby for so long, I truly just wanted a healthy baby. Still, it was cool to have the experience of an unmedicated birth. I had fabulous support from the nurses, my OB, and my husband and mom, who were both there for BabyM’s birth.

BabyM birthI have to say that the last month has been pretty blissful. I say this with a bit of trepidation, because I know that bliss isn’t always the #1 word used to describe the postpartum period, at least if we’re being honest. But I feel lucky to have this baby, and I am claiming this bliss right now. I love holding BabyM, nursing him, and even, or maybe especially, changing his diaper. He’s most alert, and amazingly, calm during diaper changes. He can be a very quiet, calm little soul, but he can also turn on a dime. His cries can sound angry, arms punching the air, face red and broken into a sweat. He did cry for the better part of three hours tonight, so while I do feel incredibly happy right now, life is not all roses. Continue reading

Bed-sharing with Young Infants: Is It Safe After All?

Does bed-sharing with infants increase their risk of SIDS, even without known risk factors such as alcohol use, smoking, and co-sleeping on a couch or chair? A recent study makes what is probably the best attempt to date to answer this question. The study, led by U.K. researcher Peter Blair, was published last week in the journal PLOS ONE and is freely available to the public (yay!).1

mother and baby

How you bed share can make a big difference to safety. Co-sleeping on couches, alcohol use, and smoking are all very risky. The mom in the photo could keep her baby safer by removing the swaddle and ensuring that her baby sleeps on his back.

Many studies have found that co-sleeping is associated with an increased risk of SIDS, but most of this risk doesn’t come from co-sleeping per se, but rather doing so in particularly hazardous conditions, such as on a couch or with a parent who has been drinking. However, there’s an important, albeit controversial, caveat to this conclusion. Several studies have looked specifically at infants younger than 3 months and still found a significant risk of bed-sharing even in the absence of these other risk factors.2–6 The current study comes to conclusions much more reassuring to bed-sharing parents. In this study, bed-sharing without alcohol, smoking, or couch/chair co-sleeping was not associated with a significant SIDS risk in infants younger than 3 months and even seemed to be protective in older babies. Both of these findings run counter to previous studies and to the sleep recommendations of the AAP, so they deserve a close look.

How was the study conducted? Continue reading

Caffeine and Breastfeeding

If anyone needs a little caffeine, it’s a new mom. My labor with Cee took me through two mostly sleepless nights, and when she finally arrived, we took a little time to nurse and get to know one another, and then our whole little family took a long nap. When we woke up, the first thing I did was send my husband to get me a latte. The second thing I did was breastfeed my new baby again. That dose of caffeine felt like good therapy to me, but what about for Cee? Was it good for her?

caffeine structure

Source: Wikimedia Commons

A few weeks ago, I wrote about the safety of caffeine in pregnancy, and several readers wanted to know about the postnatal effects of caffeine – how mom’s caffeine intake might affect her breastfed baby. I promised to take a look at the literature and report back, and so here we are.

 

When you drink a cup of coffee, how much caffeine ends up in your breast milk?

Several studies have examined this question, and although they are small, they give us a general idea of the transfer of caffeine from mom’s blood to her milk. After a cup of coffee, caffeine is rapidly absorbed into mom’s blood and then passively diffuses across the epithelial layers of the mammary gland. Caffeine appears in milk within 15 minutes of consumption and peaks within an hour. The concentration of caffeine in breast milk ends up being about 8090% of that in mom’s plasma. However, taking into account the amount of breast milk consumed and adjusting for body weight, studies have estimated that the infant receives no more than 10% of the maternal dose of caffeine, and likely much less (see here, here, and here).

Is this amount of caffeine safe for a baby?

Just because levels of caffeine in breast milk are low relative to what adults normally consume doesn’t mean that these amounts are necessarily safe to a baby. Another important factor is how efficiently a baby can metabolize caffeine, and it turns out that newborn caffeine metabolism is really slow. Whereas the half-life of caffeine in adults is around 2-6 hours, it is an average of 3-4 days in newborns and can be even slower in premature babies. In other words, a morning cup of coffee for mom will easily clear her blood by bedtime, but caffeine may linger in her breastfed newborn for much longer. Metabolism gradually ramps up as the baby matures and the necessary enzyme levels come on board, and most babies can metabolize caffeine at rates similar to adults by 5-6 months of age. Continue reading

Getting our 3-Year-Old Back to Good Sleep… In 9 (Not Easy) Steps

Yesterday, I wrote about how we found ourselves struggling with sleep with Cee. We knew it was time to make a change, and we knew this meant asking Cee to fall asleep on her own at night, without one of us sitting in her room with her. This was not exactly a new thing for her; until the last 6 months, she’d been falling asleep on her own since she was a baby. Still, given how things had gone lately, this was a big change for all of us.

I want to share how we approached this transition, but I don’t believe this is a magic formula by any means. I don’t think there are easy answers to parenting challenges like these, and what works well in one family might be a flop in another. I am proud of how we thought this through and put a plan into action, and it has seriously given our entire family (Cee included) more happiness around bedtime. Here’s what we did.

1. Husband and I did this together. All of this would have been much harder without his help. He is great at staying calm in stressful situations, which has a calming effect on Cee, and he is thoughtful and empathetic. We also recognize that our relationships with Cee are different. He’s the more fun parent; he’s more lenient with Cee in many ways but is also very good at setting rock solid boundaries when it is important. I’m still the parent that she turns to when she needs comfort. This often means a sweet hug or snuggle session, but it can also mean being on the receiving end of a bunch of messy emotions. Cee and I also tend to end up in power struggles more often, something I’m working on. Because of these differences, Husband was the parent who initially sat down to talk with Cee about bedtime changes. We also made sure he’d be around at bedtime for the first few days (he often works evenings and nights, so this isn’t always the case), so that we could take turns and he could take over if needed.

The importance of a strong parenting partnership has been shown in the research. A recent study from Doug Teti’s Penn State lab found that one of the greatest predictors of high maternal emotional availability at bedtime (discussed in my last post) was the quality of coparenting, even when dads weren’t directly involved with bedtime.

2. We told Cee about the change. We told Cee that it was time for her to start falling asleep on her own again and that we wouldn’t be sitting in her chair anymore. We didn’t dwell on trying to explain why, because we didn’t want her to feel like this change was a punishment for previous bedtime behavior. We didn’t emphasize that big girls go to sleep on their own, because that might have made her wonder if being a big girl was really such a great thing. We simply told her that she used to fall asleep on her own, and we were going to help her do that again.

3. We asked Cee to help us make a new plan for bedtime. “How do you think we can help you with bedtime now that we won’t be sitting in your chair?” Husband asked. Continue reading

How My 3-Year-Old’s Sleep Fell Apart

A couple of weeks ago, I wrote that after I finished my book, I needed a sort of parenting reset with Cee. One of the big areas that we needed to work on was sleep. Bedtime had become a battle, and it was taking Cee a long time to fall asleep. This was leaving us all frustrated at the end of the day, and Cee was waking up grumpy in the mornings. I didn’t have the energy and attention to work on it while I was trying to finish my book, although in hindsight I’m not sure why we waited this long. Over the last couple of weeks, we’ve made some big changes to get us back to happy bedtimes.

Let me back up and tell you how we got into trouble with sleep in the first place. Last August, we moved to a new house. By this time, Cee had been in a toddler bed for almost a year, but she had no problem staying in it at bedtime or through the night. We had a sweet bedtime routine that ended with kisses goodnight, turning off the light, and then good sleep for Cee. After we moved, Cee started talking about being afraid of things like the deer and turkeys that wandered through the yard of our new house. We talked about these fears, got her a night light, and spent a little more time with her before saying goodnight, singing a couple of rounds of Twinkle, Twinkle and rubbing her back for a few minutes. All of that was fine.

Then Cee started getting out of her bed after we left her room for the night. She’d pad into the living room or my office to find me. I’d walk her back to bed and tuck her in again, but some nights this happened over and over. I would be shocked to see her in my office door at 9:00 or 9:30 PM, long after her 8:00 bedtime. She was also waking up during the night, coming into our room, and patting my shoulder until I woke up. I would walk her back to her room, often lying down next to her until she went back to sleep. Alternatively, I’d pull her into bed with me, but neither of us slept very well this way. All of this was adding up to fewer hours and less restful sleep for both of us.

When did the sweetness of a good nap become something to resist?

When did the sweetness of a good nap become something to resist?

Things seemed to get worse around the holidays. Cee was getting out of bed more and more after bedtime, and she was having a hard time separating when we tucked her back in. She started asking us to sit with her while she fell asleep, and this actually seemed like a reasonable solution. At least if we sat in her room we could make sure that she stayed in her bed, and maybe she would fall asleep easier and get more rest this way. I reminded myself that she was just 3, and if she was asking for more support in her transition to sleep, why shouldn’t we give that to her? (Never mind that she had been falling asleep on her own since she was a baby.)

There was something else going on at this time, too. I thought that maybe Cee’s struggles with sleep were because I wasn’t there enough for her in the day. I was going through a really tough period, approaching the 1-year anniversary of our first miscarriage and beginning some fertility testing. Continue reading

Traveling with Kids: It Isn’t All Bad (plus 7 tips to keep it that way)

I apologize for my long absence from the blog. It’s been a busy couple of months. We finally bought a house, and with the help of many friends, got moved to our new home. Then the projects began – and continue. Summer school term wrapped up, and I’m prepping for fall term to begin in a couple of weeks. My book is coming along slowly what with all of the above. The blog has been completely neglected.

But I need to get back here. It’s like running and yoga for me; once I get out of the habit of lacing up my shoes or rolling out my mat or actually hitting “publish” on a blog post, these things I love seem to get a bit harder to do. So today,  I thought I’d share my latest installment of Things I’ve Learned About Traveling with Children. (Follow the links to previous installments on traveling with babies and toddlers).

Last week, Cee and I traveled together to Kentucky, where I grew up. It was a last-minute trip, tickets booked just days before our flight. Husband was working and couldn’t leave on such short notice. The reason for our trip was bittersweet. A dear friend died unexpectedly, and we went to mourn her loss and celebrate her life. Despite the sadness, it was a special trip with Cee. It was her first visit to Kentucky, so she met (and vice versa) lots of old friends, many of whom now have kids of their own. (I no longer have immediate family in Kentucky, so we don’t visit there often.) Together, we explored the little house where I grew up, touched the grave of my father, and splashed in the creek where I spent the summers. My mom and my brother also came, so it was full reunion of family and friends.apple tree kids

Something else made this trip special: Cee was an absolute joy as a travel companion. Until this trip, travel always felt like a scary limbo – so long as we were in airports or on planes, until we had a bed and a home base, I carried the knowledge that everything might fall apart at any moment. There could be a poop explosion on the plane or projectile vomit upon landing. My bare boobs might fly out of my shirt as my nursing baby squirmed, the two of us wedged in the middle seat between two strange men.There could be two hours of inconsolable crying on a fully booked red eye from Oregon to New York. I say this because all of these things have happened over the last few years of traveling with Cee. We’re experienced travelers, we know the tricks, and we roll with the punches when things get messy. And they usually do, so I don’t much look forward to traveling.

But now… Cee is potty trained, so no poop explosions (although she did wear a pull-up while we were flying, just in case). She can now tell me when she feels nauseous, so we had plenty of time to get out the little complimentary motion sickness bag. And she’s weaned, so no need to lift my shirt. She sleeps when she’s tired, avoiding that dangerous over-tired state. sleepy headCee is two, but when people ask how old she is, I now feel the need to add that she’ll be three in November. Especially after this trip, she doesn’t feel like a toddler anymore. Continue reading

SIDS and Bedsharing: A Pediatrician’s Perspective

I’ve been thinking about bedsharing and sleep safety for the last few months. I have devoted an entire chapter of my book to this topic. Not only is it an important question for parents, but it’s an issue with so much complexity — wrinkles and folds of factors like breastfeeding, bonding, instinct, culture, and just plain reality.

I think it is vitally important to understand the relationship between bedsharing behavior and risk of SIDS and accidental deaths. But our ability to tease apart every factor that might impact sleep safety is imperfect; there will always be factors that aren’t quantified in these studies, not to mention the fact that case control studies have some inherent limitations. You’ve probably heard about the study published this week by Carpenter et al. in BMJ. It combines 5 historic case control data sets from Europe, the U.K., and Australasia to specifically look at the risk of bedsharing in breastfed babies in nonsmoking households. It concludes that bedsharing poses an increased risk of SIDS, even in these ideal situations. I think it’s an important study, but it also has some limitations and doesn’t answer all of our questions with certainty. In fact, no study will probably ever do that. (You can read some critiques of the Carpenter study here and here.)

But even if we accept that bedsharing increases a baby’s risk of dying unexpectedly during sleep, we still have to answer the bigger question of how we translate this information to families living in the real, difficult world of infant sleep. Many families value bedsharing as a cultural practice; others choose it because it feels right. Still others bedshare because it is the only way that anyone gets any sleep at night, and we all know that sleep deprivation carries some risk, too, as does falling asleep on a couch with your baby. This is the reality.

Pediatricians face this reality in their clinics every day, when they talk with parents of new babies about sleep. In my book, one of the questions I explore is how pediatricians handle this conversation, given that their professional organization, the American Academy of Pediatrics, recommends against bedsharing. Several months ago, I sent some questions to one of my favorite pediatrician bloggers, Dr. Melissa Arca of Confessions of a Dr. Mom. She had initially agreed to a Q&A, but then she didn’t respond with her answers. It was the height of the busy flu season, and I figured that she was just busy. Then, this week, she surprised me with her responses. She had been thinking about bedsharing given the news of this recent study, and she was inspired to restart this conversation. We’ve cross-posted our Q&A on both our blogs. Check out her post for more about her initial hesitancy to address these questions, and please feel free to share your experiences in the comments below.

Alice: How did sleep look for your two children?

Melissa: My first child was a challenge to say the least. He is the one who made me question the safety of bed-sharing in the first place. For the first 6 months of his life, sleep was virtually non-existent (or at least that’s the way it felt to me) because he needed my arms and constant soothing throughout the night. But I was terrified to bedshare. I was literally at the end of my sleep deprivation rope. I had tried everything. And instead of listening to my instincts, I was fighting them. Because I was scared.

I never envisioned myself as a bedsharing parent. As a pediatrician, I was adamantly against it. But it was exactly what my baby needed and we struggled and limped along until I finally realized that.

My second child was a breeze and that’s no lie. She was always (and still is) an “easy sleeper”. She needed her space and showed clear signs of being tired. When she was tired, that was it. I didn’t need to bedshare with her. She slept in her own bassinet next to our bed during her first few months of life before being transitioned to her own room.

They could not have been more different in the sleep department. Same parents. Same environment. Different children.

Alice: As a pediatrician, how did you feel about bedsharing before having children? Did becoming a mother change that?

Melissa: I didn’t think it was safe. At all. I had read the studies and the official recommendations. Back to sleep, crib and/or bassinet in the same room with no hazards such as loose bedding, pillows, etc.

I never thought in a million years I would have become a bedsharing parent. But kids don’t have our same agendas. Continue reading

Sleep Deprivation: The Dark Side of Parenting

Sleep deprivation is an inevitable part of having a baby, and surely that’s been true throughout the history of our species. But we also live in a culture that seems to take some amount of pride in getting by on little sleep. We think of sleep as time wasted, as lost productivity. We forget – or ignore – the biological necessity of sleep.

Becoming a parent only further stretches our already-too-thin sleep allotments. Newborn babies wake frequently to feed or for comfort during the night. We try to “sleep when the baby sleeps” and piece it together to come up with a reasonable amount, but it often doesn’t feel sufficient. And now more than ever, new parents are really isolated as they make this transition; they don’t have much in the way of backup resources to help with the 24/7 job of caring for a baby.

This month, the theme of our Carnival of Evidence-Based Parenting is Transition to Parenthood. (See the bottom of this post for links to other Carnival posts and here for summaries of them all.) Sleep deprivation is a universal part of that transition. What does the sleep deprivation of early parenthood really look like? How does it affect us? And what can we do to mitigate it?

Just How Bad Is It?

For many moms, sleep debt actually begins in pregnancy, when sleep needs may increase but discomfort and frequent trips to the bathroom interfere with a full night’s sleep. But by far, the biggest change happens in the immediate postpartum period. One study found that in the first week of the baby’s life (compared with late pregnancy), moms got 1.5 hours less sleep, fragmented into three times more sleep episodes per day. The early postpartum period is also characterized by lots of day-to-day variability in sleep. Sleeping with a new baby means unpredictability, with little to no control over whether tonight will be a good night or a bad one.

Mothers usually get the majority of our sympathy when it comes to postpartum sleep deprivation, but the research shows that fathers’ sleep takes a hit, too. A study of 72 San Francisco couples welcoming their first baby compared sleep in the last month of pregnancy to sleep in the first month postpartum (around 20 days of life).  Across this time span, mothers lost an average of 41 minutes of nighttime sleep, while dads lost just 18 minutes. Moms, however, gained 30 minutes per day in daytime napping; dads didn’t get a nap bump at all. In fact, in this study, dads actually slept less than moms – both in late pregnancy and in the postpartum period. Moms still had it harder; they were waking more during the night and had more sleep fragmentation than dads (and it’s quite possible that moms need more sleep, what with recovery from childbirth and the demands of breastfeeding). But regardless, in this and other studies, moms and dads both reported a similar level of fatigue during the day.

There’s some good news to come out of this research, however. It seems that experienced moms are better at handling sleep in the postpartum period. Despite juggling more responsibility at home, studies show that moms who had given birth at least once before tended to get more sleep at all stages of pregnancy and in the postpartum period. Their sleep was also more efficient, meaning that of the time they spend in bed, they spend most of it sleeping rather than tossing and turning – or laying awake listening to the grunts and sighs of new baby sleep. Somehow, experienced moms seem to prioritize sleep more, or they’re just so tired that they crash hard at every opportunity.

How does sleep deprivation affect new parents?

We know a lot about the effects of sleep deprivation but actually very little about the specific type of crap sleep experienced by new parents. Most sleep deprivation studies have been conducted in residential labs, where participants (often young, probably resilient, undergrads) are generally paid to live for a few nights or maybe weeks so that their sleep habits can be controlled and monitored. In a review paper entitled “Sleep Disruption and Decline in Marital Satisfaction Across the Transition to Parenthood,” Gonzaga professor Anna Marie Medina and colleagues make an important point: Lab study participants know that they’ll be subjected to sleep deprivation for a finite amount of time, and they know they can even drop out if it becomes too much for them.

“Understanding that one can end a study, and being certain of the temporal parameters of potential sleep deprivation, imbues the experience of sleep loss with a level of controllability that new parents seldom have. That is, (most) new parents realize they cannot opt out of the sleep disruption experience, and they have no certainty about when they may have an opportunity for sufficient sleep. The stress literature has suggested that such uncontrollability could amplify the mood and physiological consequences of sleep deprivation.”

In other words, most of what we know about the effects of lost sleep may be even worse in new parents. On that happy note, there are a few major areas of concern… Continue reading

6 Tips for Sweet Newborn Sleep

Nothing can prepare you for the changes in your sleep when you welcome a newborn baby into your family. Experienced parents will issue dire warnings and tell you to sleep while you can during the last few weeks of pregnancy. (And you will think, yeah right, there’s a large boulder resting on my bladder, and sometimes it kicks for good measure.)

But then the baby arrives, and your world changes forever. Sleep disruption is one of the most immediate and dramatic changes associated with parenthood. It isn’t just that you’re getting less sleep; it’s that your sleep is suddenly dependent on this baby sleeping. And even though newborns sleep a lot – as much as 16-18 hours per day – it feels disorganized and unpredictable.

The thing is, babies, even brand new ones, actually do have organized sleep, it just isn’t organized like yours. But under the surface, baby is working towards being more like you in his sleep. During the first few months, you have no choice but to go with the flow and sleep when the baby sleeps (something I was never good at), but it can help to understand the inherent patterns in your baby’s sleep/wake cycles so that they become more predictable. Your goal is to work with your baby’s biology, find some time for your own sleep, and support your baby in his natural development towards more mature sleep patterns.

In the research for my book, I’ve buried myself in research papers on infant sleep, trying to glean some knowledge that can be helpful to parents in these first few months of baby’s life. Here’s what I’ve come up with so far:

1. Understand newborn sleep cycles. Newborn sleep alternates between active and quiet sleep (akin to REM and non-REM sleep in adults). During the first few months of life, infants usually begin each sleep period in active sleep. Then, after about 25 minutes, they’ll transition to a cycle of quiet sleep, also about 25 minutes long. During active sleep, babies will twitch and flail their limbs, grunt and sigh, and maybe even cry a little. Their eyes move beneath translucent closed lids and may even open from time to time. In quiet sleep, babies breathe slowly and rhythmically, and their bodies are still 1,2.

Why care about the biology of sleep? Because it can help you in these practical ways:

  • Babies wake easily from active sleep, so if your baby falls asleep in your arms, wait until you see signs of that deeper, quiet sleep before you try to move him.
  • Around the 45-50 minutes mark, baby will be finishing up that first active/quiet sleep cycle of 45-50 minutes. Transitioning from one cycle to the next can be tricky for a new baby, so if he wakes during this time (particularly if it’s after just one cycle), see if he wants your help returning to sleep before assuming that he’s ready to eat or play.
  • Active sleep is noisy. Parents often mistake the normal vocalizations of active sleep as the baby waking, and in their efforts to soothe the baby, they’ll actually wake him up. If you think your baby is waking up, pause and watch him for a moment. He may just be dancing in his sleep, or he might be waking briefly only to return to sleep on his own.

IMG_42252. Help your baby find a rhythm. We are adapted to Earth’s 24-hour cycle of light and dark, and our physiological circadian rhythms help us to feel awake during the day and sleepy at night. Newborn babies, on the other hand, sleep just as much during the day as they do at night. It takes them some time to develop rhythms to match our day/night cycle. You can help by sending baby strong environmental and social cues about day and night. Continue reading