Sleep Problems

Tips to Preventing Sleep Problems

Newborn

• Place your baby in the crib when he/she is drowsy but awake.
• Hold your baby for all fussy crying during the first 3 months.
• Carry your baby for at least 3 hours each day when he/she isn’t crying.
• Do not let your baby sleep for more than 3 consecutive hours during the day.
• Keep daytime feeding intervals to at least 2 hours for newborns.
• Make feedings in the middle of the night brief and boring.
• Do not awaken your infant to change diapers during the night.
• Do not let your baby sleep in your bed.

Two Months

• Try to delay feedings in the middle of the night.
• Give the last feeding at your bedtime.

Four Months

• Try to discontinue feedings in the middle of the night before it becomes a habit.
• Do not allow your baby to hold his/her bottle or take it to bed with him/her.
• Make any contacts in the middle of the night brief (less than 1 minute) and boring, except if you feel he/she is sick, hungry, or afraid.

Six Months

• Provide a friendly soft toy for your child to hold in his/her crib.
• Leave the door open to your child’s room.
• During the day, respond to separation fears by holding and reassuring your child.
• For middle-of-the-night fears, make contacts prompt and reassuring.
• Move the crib to a separate room.

One Year

• Establish a pleasant and predictable bedtime ritual.
• Once put to bed, your child should stay there.
• If your child has nightmares or bedtime fears, reassure him/her.
• Do not worry about the amount of sleep your child is getting and keep naps to less than 2 hours long.  He/she is getting enough sleep if he/she is not tired during the day.

[Adapted from Pediatric Telephone Advise, 2004, by Barton D. Schmitt, M.D.]

Sleep Problems: “Trained Night Feeder”

A “trained night feeder” is a child who:

• Is 5 months or older and awakens for feeding at night, on most nights.
• Is bottle- or breast-fed until asleep.
• Awakens to be fed at night since birth.
• Is less tired than his/her parents.

What to do for a “trained night feeder”:

•  Gradually lengthen the time between daytime feedings to 3 or 4 hours.
•  At naps and bedtime, place your baby in the crib drowsy but awake. This is so he/she can learn to put himself/herself to sleep without the breast or bottle.  Once he/she is in the habit of putting himself/herself to sleep, he/she can then do the same when he/she awakens at night.
• If your baby is crying at bedtime or naptime, visit your baby briefly (up to 1 minute), every 5 minutes for younger or more sensitive babies, gradually increasing time to every 15 minutes.
• If your baby is crying during the middle of the night, try soothing him/her by the bedside for 5 minutes. If he/she continues to cry, temporarily hold him/her until asleep.
• After the last feeding of the day feed him/her only once during the night and only if 4 hours have passed since the last feeding.  Make this feeding boring and brief (no more than 10 minutes).  Stop feeding before he/she falls asleep, and replace it with holding only.
• Stop giving your baby any bottle in bed.
• Help your child attach to a security object, such as a cuddly stuffed animal, other soft toy, or blanket.
• Eventually phase out the nighttime feeding.  Do this when the time between daytime feedings is more than 3 hours and your child can put himself/herself to sleep without feeding or rocking.  Gradually reduce the amount you feed him/her at night.  Reduce one ounce of formula every third night.  For breast-feeding, nurse on just one side and reduce the feeding by 2 minutes every third night.

Sleep Problems: “Trained Night Crier”

A “trained night crier” is a child who:

• Is 5 months or older and wakes up and cries most nights since birth.
• Is held, rocked, or walked until asleep.
• Does not need to be fed in the middle of the night.
• Is less tired than his/her parents.

What to do for a “trained night crier”:

• At naps and bedtime, place your baby in the crib drowsy but awake.  This is so he/she can learn to put himself/herself to sleep without the breast or bottle.  Once he/she is in the habit of putting himself/herself to sleep, he/she can then do the same when he/she awakens at night.
• If your baby is crying at bedtime or naptime, visit your baby briefly, every 5 minutes for younger or more sensitive babies, gradually increasing time to every 15 minutes.
• Make visits brief (up to 1 minute), boring, but supportive.  Speak reassuringly to him/her and do not show anger during these visits.  Touch him/her gently and help him/her find his/her security object.
• Do not remove your child from the crib.
• If your baby is crying during the middle of the night, try soothing him/her by the bedside for 5 minutes.  If he/she continues to cry, temporarily hold him/her until asleep.
• Help your child attach to a security object, such as a cuddly stuffed animal, other soft toy, or blanket.
• Eventually phase out the nighttime holding only after your child has learned to quiet himself/herself and put himself/herself to sleep for naps and at bedtime.  Go to him/her every 15 minutes while he/she is crying, but make your visits brief (up to 1 minute) and boring. 

Other ideas for both “trained night feeder” and “trained night crier”:

• Move the crib to another room. If he/she must stay in your bedroom, cover one side rail with a blanket so he/she cannot see you when he/she wakes up.
• Avoid long naps during the day. If he/she has napped for more than 2 hours, wake him/her up.  If he/she has the habit of three naps during the day, try to change this to two naps a day.
• Do not change wet diapers during the night.  Change them only if soiled or if treating a bad diaper rash.
• If your child is standing up in the crib at bedtime, try to get him to lie down.  If he/she refuses, you can leave him/her standing up.  Eventually, he/she will lie down without your help.
• Keep a diary of when your baby is awake and asleep.  Bring it to the office for your doctor to review.

When to Call the Doctor

Call your child’s doctor if:

• He/she is not gaining weight.
• His/her crying seems to be due to a physical cause.
• He/she acts fearful.
• there is someone in your family who cannot stand his/her crying.
• the above suggestions do not improve your child’s sleeping habits after 2 weeks.

[Adapted from Pediatric Telephone Advise, 2004, by Barton D. Schmitt, M.D.]