Recently, a friend contacted me about some sleep difficulties she was having with her baby:
My 7 month old has started waking up more frequently in the last several weeks after a cold. For the last several months, she has slept through the night with only a single awakening at night. However, she recently had a cold and started waking up every 1.5 -2 hours at night. Now the cold has resolved but she awakenings remain! She typically falls asleep at the breast every evening after her bedtime routine, which includes a bath, a story and some songs from her father before I nurse her. She awakens frequently the night and I nurse her back to sleep. These feedings are brief and I don’t think she is getting very much milk. She has started wetting through her diapers, however. Her first awakening is about 2-3 hours but she awakens every 1 ½ hour for the rest of the night. She awakens in the morning around 7 AM and naps from 9-10 AM and 1-:2:30 PM. Lately these naps have been shorter as well.
This is a typical story– so typical, in fact, that we experienced something very similar. When my older son was about six months of age, he had been sleeping through the night for about one month. He started to wake up once, then two to three times a night to nurse. Our routine had been for my wife to nurse him to sleep then place him in his crib. He had reached an age, however, where a) he did not need middle of the night calories anymore and b) he was old enough to self soothe which typically occurs around 4-6 months. This is the appropriate time to start putting your child to sleep drowsy but awake so he or she does not develop inappropriate sleep onset associations which can cause nocturnal awakenings. If your infant’s sleep starts to worsen around 4-6 months, it is time to “flip the switch” and stop nursing or feeding to sleep at bedtime.
Here was my advice to my friend:
- Pick a convenient date to start addressing this issue. I think it is critical to pick a “quit date.” Don’t start sleep training right before the holidays or if you have visitors coming.
- Try switching your bedtime routine so we can separate nursing/feeding from sleep onset. Thus, instead of bath -> story -> song -> nursing -> bed, change the order e.g. nursing -> bath -> story -> song -> bed. This is a great opportunity for the dad (or non-nursing partner) to take a more active role in bedtime.
- Please place the baby in the crib drowsy but awake.
- See if your child benefits from checking. Do checks calm your child or upset them? If you decide to check, check every 5 minutes. Checks should be brief and without contact. “I love you, you’re fine, good night”.
- As for the night-time awakenings, they will extinguish on their own. Frequent feeding will reinforce them. For this family with a child at the 90% for weight, I recommended Dad offering a 2 oz bottle of water at night.
I just heard back from my friend and this prescription was effective in about a week. I think that the second piece of advice is the most important. As parents, we get in the habit of wanting to nurse or feed our infant immediately before bedtime so as to maximize the sleep time before the next awakening. However, provided your child is growing well, there is little biological need for calories at night after six months of age. Obviously, if your child has nutritional or growth difficulties the calculus may be a bit different. (If your child is older, or feeding multiple times per night, you may need to address this separately. Here’s an article on how to stop night feedings when they are out of control).
I’d be curious to hear the experience of other parents in this context. Please share what working for you (and what didn’t) in helping your infant sleep through the night.