Pulling Baby out of the Crib
Up to the time he was 10 months old, my son David had always been a good sleeper. Then my family moved into a new house, and all of a sudden, all bets were off. He began waking two, sometimes three times a night. I was sure he was just unsettled by the change and would return to his old ways soon. But after we tried every trick in the book only to suffer more sleepless nights, we caved in. One night when he called out, I scooped him up and brought him into our bed. We all slept soundly, and I was feeling pretty good -- until I spoke with a friend later that morning.
"Don't you know that you've opened a can of worms?" she scolded. "Now you'll never get him back into his crib!"
Picturing endless sleepless nights ahead, I panicked, and it's no wonder. Getting a baby to sleep consistently through the night can seem like the ultimate unattainable goal. But after I spent just a few nights leaving my son in his crib when he cried for me and gently encouraging him -- "You're okay, David, just go back to sleep!" -- from the hallway, he quickly resumed his old sleep habits. And experts say that with some patience and effort, most parents will be able to solve their child's sleeping problems, too.
The Impossible Dream
During the first weeks of life, you can't expect a baby to sleep through the night. In fact, there is no typical sleeping pattern for newborns; the only thing you can count on is that they sleep around the clock for varying periods, ranging from a few minutes to a few hours. So why can't they sleep consistently for long periods? Blame it all on biology. An immature brain is the primary reason.
"People have a genetic timing mechanism in their brain that controls sleep, and it takes time for that mechanism to develop," explains Marc Weissbluth, MD, professor of clinical pediatrics at Northwestern University's Feinberg School of Medicine, in Chicago, and author of Healthy Sleep Habits, Happy Child (Ballantine). "Think of it like eye color: Babies are born with a genetic predisposition to a certain eye color, but it takes time for that color to be expressed."
A need to feed is another factor. Many experts believe that newborn babies have to eat frequently, particularly breastfed babies: There's no way to tell how much a breastfed baby is eating at each feeding, so breastfeeding mothers may be more likely to fully awaken a stirring baby to feed.
Bottlefed babies, on the other hand, may sleep for longer periods because formula takes longer to digest and leaves baby feeling fuller longer. "But babies who have birth defects and are fed continuously by tube for the first several weeks of life show the same process of sleep maturation as other babies," notes Dr. Weissbluth. He believes that ultimately, "Sleep comes from the brain, not the stomach."
Regardless of studies and experts, until she is at least 6 weeks old, a newborn baby will undoubtedly wake several times during the night. Around the 6-week mark, many babies show subtle signs of organizing their sleep. They may get drowsy at 6 or 7 p.m. and may sleep at night for consecutive blocks of four hours or more.
At about 3 months, most can adhere to a sleep schedule that includes a morning nap, an afternoon nap, and two or more longer blocks of sleep at night. According to a poll of primary caregivers by the National Sleep Foundation (NSF), a nonprofit organization, by 9 months some 70 to 80 percent of babies are sleeping a straight 9 to 12 hours every night.
That's great news -- unless yours is one of the 20 to 30 percent of babies who don't sleep so well. "My son was a horrible sleeper!" recalls Lisa Henahan of Peachtree City, Georgia. "Until he was 15 months, he would sleep for an hour and a half and then wake for an hour -- all night long!"
If your nights sound similar, rest assured, these tips can help parents solve a range of stubborn sleep problems.
Sleep Tight, Baby
To exhausted parents it seems that there are as many sleep issues as there are children. But most babies fall into the following categories:
"My 2-month-old son sleeps all day and is up all night."
A common phenomenon during the early weeks of life, day-night reversals often clear up with a little time and a lot of daylight. Try exposing your baby to bright light or sunshine in the morning hours and keep the lights dim in the evening. It also helps to move your baby to a busy part of the house throughout the day, play with him during the daytime, and wake him for daytime feedings.
Then, keep your interactions with him quiet and subdued at night. As babies approach the age of 6 weeks, they begin to respond more to environmental cues, so it helps to have a bedtime routine such as a bath and a song. It may take several weeks, and a baby this young still probably won't sleep through the night, but he may consolidate his sleep into two large blocks at night.
"My 7-month-old daughter won't sleep through the night. Why?"
From around 6 months on, a baby should be able to make it through the night without a middle-of-the-night feeding and without waking his parents. But that doesn't mean he's sleeping all those hours. The term "sleeping through the night" is misleading, points out Lawrence Balter, PhD, professor of applied psychology at New York University, in New York, and editor of Parenthood in America: An Encyclopedia (ABC-CLIO, 2000). "All people -- including babies -- wake and put themselves back to sleep several times a night without realizing it," he says. "That's something babies need to learn to do."
Some kids learn on their own; others need a little help. There are several ways to teach your baby to soothe himself to sleep. Most of them involve listening to some crying. So how do you stay focused amid the tears? Remember that crying isn't going to harm your baby. And the reward -- a good night's sleep for all -- is worth a few teary nights.
The Ferber Method
"My neighbor has recommended the Ferber method to help my 6-month-old sleep through the night. What is it?"
This method was developed by pediatric sleep expert Richard Ferber, MD, author of Solve Your Child's Sleep Problems (Simon & Schuster, 1986). He advises parents to check periodically on their baby when she awakens at night. Here's a sketch of how it works: On the first night, when you hear your baby cry, you go in, give her a reassuring pat, and then leave. If she's crying 5 minutes later, you repeat the process, but this time you wait 10 minutes before going in, increasing the time in five-minute increments. The second night, you start at 10 minutes. Dr. Ferber's system has worked for many families.
"We're trying the Ferber method for my 7-month-old, but I can't stand the crying. Is there another, less drastic way to sleep-train my baby?"
There are also ways of making gradual changes within the routine you already have, notes Jodi Mindell, PhD, associate director of the Sleep Disorders Center at The Children's Hospital of Philadelphia and author of Sleeping Through the Night (HarperCollins, 1997). If you've been putting your baby to sleep by rocking her in a chair, for example, start by just sitting in the chair together. "Then choose the next step -- putting your baby in his crib and holding his hand.
"A few days later, you can sit three feet away from your child's bed," Mindell says. Within a few weeks, you should be able to work yourself out of the bedroom.
"We've tried the Ferber method. My 6-month-old becomes enraged every time we go in to soothe him. Any suggestions?"
Some children respond better to a cold-turkey approach. If your baby cries, you don't go in her room (some parents call reassuringly from the hall). This is not for the faint of heart, and, as Balter points out, is better for younger babies. An 8-month-old may be able to sit or stand in her crib, which makes it hard for her to settle down if her calls aren't answered.
More Sleep Issues
"My 9-month-old insists on a 3 a.m. feeding. How can I get her to give it up?"
For many parents, a final obstacle to an uninterrupted night is that middle-of-the-night feeding. If your baby no longer needs to be fed at night (check with your pediatrician to be sure), simply stop giving him the bottle or breast when he calls for it. Alternatively, you can use a sequence of progressive steps, which might include offering him diluted formula or breast milk for a few nights and then gradually replacing it with water. He may not find it as appealing as milk, and, subsequently, won't cry for it.
"My 10-month-old son used to sleep through the night, but lately he's been waking up all the time."
Chances are, there's been some change, however subtle, in your child's routine. Everything from a vacation to an illness to an overnight guest can disrupt a young child's sleep schedule and cause her to awaken and need comforting. Some parents report that developmental milestones, such as learning to walk or use the potty, can also upset sleep patterns.
"When a child takes a developmental leap forward, neurons are firing and there are probably connections being made in the brain," says Mindell. "It's no wonder their sleep is disrupted." Most babies are also keen on practicing their new skills; when they wake in the night, sleep takes second place to getting up on all fours or babbling.
At times like this, you may need to repeat old steps, such as sitting in your baby's room for a few nights and gradually working your way back out. But don't despair; experts say children with established good sleep patterns will return to them pretty quickly.
"How can I get my 8-month-old to go to sleep at the same time every night?"
If your baby isn't sleepy at the same time every night, her daytime sleep routine may need tweaking. "Make sure to wake her at the same time each morning, keep naptimes consistent, and avoid letting baby nap after 4 p.m. A reasonable bedtime for a baby this age is around 7 or 7:30 p.m. If she wakes from a nap at 5:30, she's not going to be sleepy enough to go to bed then," says Mindell.
One strategy to avoid, however, is shortening her naps in the hope that this will make her sleepier at night. The fact is, overtired children have a hard time falling asleep. And evidence shows that babies aren't getting enough sleep as it is. Many experts recommend that infants ages 3 to 11 months get 14 to 15 hours of sleep daily, but according to the NSF poll, most babies get fewer than 13 hours.
Even if you've succeeded in creating a great sleeper, remember that every child occasionally has wakeful periods. When this happens, reassure yourself that you're not going to be sleepless forever. Says Peggy Nona, a Rochester, Minnesota, mother with two school-age girls, "I used to worry about getting them to bed at night; now I worry about getting them out in the morning!"
Barbara Solomon is a mother of three and a writer in Scarsdale, New York.
Originally published in American Baby magazine, July 2004.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.