"The Wee Hours:
Getting Your Baby To Sleep Through The Night"
Rachel Biale (c. 1989)

While rolling over, walking and talking are important developmental landmarks for all babies, getting them to sleep through the night is a critical step forward for parents! Most new parents would give the world for a good night's sleep. In fact, there is a lot you can do to promote your baby's development of good sleeping patterns and encourage your baby to reach that magical point of "sleeping through the night."

NEWBORN SLEEP PATTERNS

When your newborn baby first comes home from the hospital, the main problem is often that the baby's daytime sleep and nighttime sleep are reversed. This is not surprising. The baby comes out of total darkness in utero, into the hospital nursery where the lights are on 24 hours a day. Most babies can adjust to a day and night schedule on their own in two or three weeks, but that is a long time to stay up all night!
To shorten the adjustment period, first minimize stimulation at night. Feed, burp, change and hold the baby quietly, quickly and in the dark. During the day, try to keep the baby awake and active for 20-30 minutes after each feeding by changing positions, moving around, and providing visual stimulation and a variety of sounds. Most average size babies may sleep 3 hours between feedings at night (4 or more if you are really lucky), and nurse every 2 plus hours during the day. It is a rare baby that can accommodate to the proverbial "4 hour schedule." It also helps to remember that "3 hours between feedings" is calculated from the beginning of one feeding to the beginning of the next. Given that in the very beginning feeding, burping and diapering may take nearly an hour, that leaves you with barely 2 hours of sleep at a time.

Once your baby gets on a more reasonable schedule of waking two or three times a night (that is between 8PM and 6 PM), you are in better shape. Nevertheless, you may still be in for a fairly long haul before you get your full night's sleep. Some babies start sleeping through the night on their own around three or four months. But most babies need at least one night feeding for quite a while longer. A general rule of thumb is that by the time your baby is about seven months old and weighs at least 14 pounds, she can make it through the night without being fed.

However, some babies are just plain ravenous! If your baby seems hungry often both during the day and at night, s/he might still really need that 2 a.m. feeding. However, if the baby is unusually hungry only at night, then it is likely that she is waking for your company and comforting, not the calories.

Here is what you should start doing at 3 months in order to encourage the baby to sleep through the night: introduce a security blanket, put her in the crib awake, and establish a "going-to-sleep" routine.

SECURITY BLANKET

Help your baby get attached to some kind of security blanket. The technical term is "transitional object"--a blanket, stuffed animal, cloth diaper with a smooth satin edge sewed on-that becomes a trusted friend and comforting aid. The security blanket will help your baby for a long time in going to sleep, separating from you, and comforting when she gets hurt. Some parents worry that their child will get overattached to the security blanket and will go off to college clutching it to her chest. You need not worry, as your baby grows, set gradual, reasonable limits on using the blanket.

Some babies make an attachment to a soft cuddly object on their own, but many do not. You can "teach" your baby to become attached to and use a security blanket. Have the baby hold the security blanket when she nurses or has a bottle, and when you put her in the crib, and touch it to the baby's face when you are rocking and comforting her. Make sure that the transitional object is clearly distinguishable from other cuddly toys or blankets, and that you have a duplicate in reserve in case it gets lost. Do not wash the security blanket for the first month or two so it will have your scent. The baby will be quicker to associate the blanket with the soothing you provide.

INTO THE CRIB AWAKE

Many young infants are accustomed to falling asleep on the breast, on a bottle or while being rocked in their parent's arms. This works for the first two to three months. But between three and four months, it is very important to start putting your baby down in the crib awake every time she goes to sleep, so she'll learn to fall asleep in the crib on her own. Using a soothing object, such as security blanket, helps a lot but do not use a bottle (it causes tooth decay and dependence on feeding as a way of going to sleep). If your baby needs a pacifier to fall asleep you can solve the eternal "lost pacifier" problem by attaching the pacifier to the security blanket.

Go through your bedtime routine, then swiftly and smoothly put the baby in the crib and say your "good night." If the baby really fusses, stay with her until she goes to sleep but try to use just your voice to calm her down. If she gets really mad, you can try to pat her and if that does not help, pick her up, soothe her for a couple of minutes and put her back down in the crib, still awake. Don't let her fall asleep in your arms! This can be very trying with some babies. You may have to repeat the "picking up-soothing-putting down" routine over and over, for up to an hour on the first night. It'll be much easier on subsequent nights.

If you start early enough (3 months) and you first get your baby attached to a transitional object, she'll learn to fall asleep in the crib very soon. This is critical: learning early how to fall asleep in the crib will enable the baby to go back to sleep by herself in the middle of the night later, when she no longer requires a nighttime feeding. If the baby is accustomed to falling asleep in in your arms at bedtime, she'll need you in the middle of the night, too.

CONSISTENCY AT BEDTIME: A "GOING-TO BED" ROUTINE

Start establishing a very simple, consistent "going-to--bed" routine, such as bath, diapering, nursing or bottle, a song and "into the crib." The importance of this routine is that it establishes a predictable set of events which will help your baby "unwind" and get ready to go to sleep.

When you wean the baby from the bottle or the breast, gradually replace the feeding with "cuddle-time." a brief bedtime story or song, or saying good night to the moon and the stuffed animals in the room.

THE SLEEP ROUTINE

If you have done all the "preparatory work" and your baby does not start sleeping through the night on her own by the time she is seven months and weighs at least 14 lbs you can start the "sleep routine training." Similarly, if your baby did sleep through the night for awhile and started waking up again (a very common occurrence), start the sleep routine. However, if your baby starts waking up after having slept through the night, first, ask yourself what is going on in her life. Any of the following events, and other similar changes, can cause sleep disruption:

* Changes in the family, such as a trip, someone's absence, an illness, a move to a new house or a new room (or even rearranging the baby's room and crib)

* The onset of "stranger anxiety" (usually around 8-9 months)

* Teething, ear infections, other illness

* Starting to crawl or walk or other major developmental advances

* A new child care arrangement

If any of these situations have occurred, you must first address them. With an illness or teething, wait for it to pass. With changes involving separation or greater mobility allow some time for adjustment and increase your physical closeness during the day.

If your baby has been getting bottles in the middle of the night, start by gradually watering down the formula so that within 4-5 nights it is down to plain water. Some babies will stop waking by themselves at that point. If the baby is still waking, then start the sleep routine. If your baby has been breast feeding at night, you can try to have Dad offer her a bottle in the middle of the night. Again, some considerate babies will stop waking up when offered a bottle instead of the breast. Most, however, will continue to wake up and will require the sleep routine.

The sleep routine is simple and effective, but it is often very hard for the first few nights. One of the parents (preferably the father, if the mother is nursing) sleeps in the baby's room for a few nights. Whenever the baby wakes up try to get her back to sleep by just using your voice: "Daddy is here, go back to sleep." If the baby is very upset, you can try patting her along with talking. If that does not work (i.e. another ten minutes of real screaming), pick up the baby and soothe her in your arms (no breast or bottle, though!) When she calms down, but before she falls asleep in your arms, put her back in the crib. This may create the "yo-yo effect," you'll be picking her up, soothing her and putting her down to renewed howling, over and over. Do not despair: this is the essence of the "training:" reassuring the baby that the parent is there to comfort her, but insisting that she fall asleep in her crib. Eventually the baby will fall asleep in exhaustion.

It's a good idea to keep a clock that you can see in the dark in the baby's rooms. That way, you can see how much time has actually gone by: it will seem like hours! Keep a log of how long it takes the baby to go back to sleep each time, and how many times she awakens at night. Most likely you won't be needing the log after a week.

The sleep routine is not a remedy "once and for all." You do it every time your baby starts waking up at night. Most infants and toddlers have recurrent periods of sleep disruption due to illness, changes, the separation process and other anxieties. Each baby is different and each circumstance has its unique features; these suggestions are general guidelines, not a "recipe." If you find that the suggestions outlined here do not work for you and your baby, you should seek professional, in-person assessment of your baby, and guidance and counseling for you as a parent.

Rachel Biale is a Licensed Clinical Social Worker experienced in counseling parents of young children regarding normal developmental problems, adjustment to parenting, and treatment of children with emotional difficulties. These suggestions are based on the sleep routine originally developed by the Warm line at PIPS, Thallans Mental Health Center, Cedars-Sinai Medical Center, Los Angeles, California.

If you have any further concerns about your child's development and behavior, your family, or your own adjustment to parenting, you may call Rachel Biale for consultation and counseling.

Parenting Counseling By Phone 510-525-5484

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