Going to Sleep and Staying Asleep in the First Year
Before your baby is 3 or 4 months old, she is unlikely to have a regular sleep pattern. There is little point in trying to control her sleep, other than gently encouraging daytime wakefulness and nighttime sleep. By 4 or 5 months — a little later for those who were born prematurely —babies are capable of establishing a regular sleep pattern and tend to sleep through the night.
Although we think of "sleeping through the night" as a long stretch of uninterrupted sleep, in reality, all babies wake up during the night. Some discover their own way of comforting themselves and getting back to sleep, while others must be taught.
Different experts recommend different techniques for helping your baby get to sleep and then to sleep through the night. If your baby is having problems getting to sleep or staying asleep, you might want to try one of these techniques or discuss various sleep strategies with your pediatrician.
Despite the differences, most experts agree on the following points:
• Establish a consistent daily schedule of sleeping, feeding, bathing and playing times.
• Babies benefit from a regular bedtime routine.
• A good sleep environment consists of a dark (but not too dark) and quiet room.
• A transitional object, such as a soft toy or blanket, can help an older infant fall asleep.
• A baby should be put to bed when drowsy, but not yet asleep so she can learn to fall asleep on her own.
• Make nighttime visits boring for your baby. Feed your baby if she is hungry, but not if she is looking for comfort. Change her diaper if it is soiled or very wet. Otherwise, offer only a minimum of stimulation at most.
• Undertake any sleep program only with the full agreement and consistency of all the adult caretakers.
• Let a fussy baby lie, and see if she falls back asleep on her own.
Two of the most popular methods of getting babies to sleep and helping them sleep through the night are described below.
This method was popularized by Dr. Richard Ferber. After you've put your baby to bed or when she wakes up in the night, let her cry for a few minutes. Then go to her side and reassure her with soothing words and a pat — don't pick her up. Leave the room while she is still awake, and let her cry a little longer before your next visit. Repeat this pattern, extending the interval between visits each time, until your baby is asleep. On the following night, wait a little longer before your first visit, and make subsequent visits a bit further apart.
If your baby is accustomed to several nighttime feedings, you will probably have to eliminate them gradually by increasing the time between feedings over several nights. It may be helpful for nursing babies if the father makes nighttime visits when the baby isn't truly hungry.
If this method isn't working after one or two weeks, check with your pediatrician.
Even babies who learn to sleep through the night may go through periods of night awakenings, particularly around 8 or 9 months old. At this age, "separation anxiety" first appears, and your baby is learning new motor skills, such as crawling, sitting, standing and climbing. A new awareness of her surroundings and being separated from you, or the excitement of practicing her new skills, may interrupt your baby's normal sleep pattern. If you have been stopping in to soothe her, consider calling to her rather than appearing at her side. Some babies benefit from having their bedroom door kept open a crack, so they can hear you.
Crying it out
Put your baby to bed awake and let her cry, or don't respond when she wakes and cries in the night. It may feel like an eternity, but sooner or later she will fall asleep. Repeat the following night; she'll probably cry for a shorter time. By the third night, you may only hear brief fussing. This technique works quickly (within a week) for most babies. If your baby isn't one of them, check with your pediatrician.
Dr. Marc Weissbluth offers a cry-it-out approach with some qualifications. He believes that children who aren't sleeping well may not be getting enough total sleep. Beginning around 5 or 6 weeks and continuing through the eighth month, most babies should not be awake longer than 2 or 3 hours at a time during the day. A baby should be put to bed before she becomes overly tired. Once in the morning and once in the afternoon (and possibly once in the early evening), soothe your baby, put her down to sleep, and give her some time to see if she falls asleep on her own. Let a younger baby cry for 5, 10 or 20 minutes before picking her up. An older baby can cry up to an hour. At about 9 months, you might need to eliminate a third nap if it interferes with bedtime.
Your baby's bedtime should be fairly early (between 6 and 8 p.m.), which keeps your baby from getting overly tired and will not cause your baby to wake early. Be a little flexible, depending on how tired she is. A baby can "cry it out" at bedtime for quite a while. Be patient — if you check on her, you will reinforce wakefulness.
One consequence of the earlier bedtime, especially for younger babies, is the possibility of one or two night awakenings to which you should respond. Your baby might be hungry because of the time that has elapsed since her last feeding. She may have a wet or soiled diaper or need another feeding during a second awakening. Do not respond to all nighttime awakenings; decide what times you will respond for feedings, and don't waver.
For more information on solving sleep problems, try these books:
- "American Academy of Pediatrics Guide to Your Child's Sleep"
- "Solve Your Child's Sleep Problems," by Richard Ferber, M.D.
- "Healthy Sleep Habits, Happy Child," by Marc Weissbluth, M.D.