One of the biggest questions I get in Sleep Clinic is, “why does my baby wake up crying at night?” Infant and toddler night waking can cause serious sleep disruption for the whole family. There are a few common reasons for this, and you need to identify the reason before you can fix it.
Every parent has experienced the dreaded 2 AM call. You hear your little one stirring on the monitor. Either you wait, fingers crossed, to see if they go back to sleep and they don’t, or you run in there as fast as you can to stuff the pacifier in their mouth before they really wake up. Most babies are capable of sustained sleep (6-8 hours in a row) at night by age six months. If you are nursing your child, it may take them a bit longer to achieve this. I think that it is reasonable that every child should sleep through the night most nights by 9-12 months of age. Now, every child wakes up sometimes at night. I view the awakenings as a problem if they are more than a few minutes in duration, occurring multiple times at night, or resulting in significant daytime irritability for either the child or the parents.
If your child is having problematic night waking, there are a few possible causes:
- “Inappropriate” sleep onset associations. This is the classic sleep disorder of childhood described popularized by Dr. Ferber. Your child falls asleep under conditions that aren’t present later in the night (that’s was “inappropriate” means here). For example, you are rubbing his back or holding her; she is nursing; he has a pacifier in his mouth. During the night your child cycles through deeper sleep, lighter sleep, and then may wake up for a minute or two every few hours. If the conditions aren’t present (e.g. she’s not in your lap) she will cry out until you go back in and pick her up. You fix this problem by teaching your child to fall asleep on his/her own by having them go to bed drowsy but awake. Sometimes, moving their bedtime later by 30 minutes may help with this process. They may fuss for a night or two but the awakenings should go away in a week. Here is my comprehensive review of sleep training techniques.
- Learned hunger. This occurs in children who are drinking a bottle or two of milk or nursing for prolonged periods at night. They are conditioned to expect food at night so they wake up looking for it. If your child is over one, healthy, and feeding multiple times at night and requiring diaper changes, this is likely your problem. If your child falls asleep eating or nursing you may have sleep association issues as well. I recommend reducing the volume of the bottles by an ounce or increasing the intervals between nursing by an hour nightly which should address this. Going “cold turkey” is hard because your child is actually hungry and you need to wean them off this. Here’s my article on how to stop night feeding.
- Medical disorders. Many common medical problems are overlooked as a cause of sleep disruption. If your child coughs frequently at night they may have asthma which needs to be treated. Acid reflux can be associated with belly pain and vomiting at night. Obstructive sleep apnea is a very common problem associated with snoring which can disrupt sleep. I would definitely recommend seeing your pediatrician about any of these concerns.
- Environmental factors. These tend to be obvious. Is there a TV on in the room? If so, please take it out of there! Is there loud noise from neighbors or the road outside? Does the child share the room with a sibling or parent who makes a lot of noise? A white noise generator or fan can be useful in these circumstances. If the room is hot or cold (>75 degrees or less than 60 F) it can also be a factor. A good bedroom should be quiet, cool, and cozy. And please keep televisions and other electronics out of the bedroom.
- “Too much time in bed syndrome”: Brett Kuhn coined this term. This may occur in older toddlers whose parents have kept the same schedule they had previously as they need less and less sleep. Imagine a child who was sleeping from 6 PM to 6 AM at age 1. Age age 3, this is likely too long a sleep opportunity, especially if the child is still napping. This child’s sleep needs may have decreased from 14 to 11 hours per 24 hour period. Thus, if you keep the same nocturnal sleep period, your child may be awake for an hour or two at night. Usually in this scenario, your child is happy when she wakes up at night and is well rested in the morning. This may be right time to get rid of a nap or consider a later bedtime. For more information, here’s my post on how much sleep kids need.