Sleep problems (babies): Home Doctor & Self Therapy

In the first 3 months of a baby’s life, night waking is to be expected because all babies need to be fed at night. Some continue to need night feedings for up to 6 months. Sleep problems in these early months tend to center on getting a baby to settle again after a feeding, particularly at night, or the baby waking again after a short time. Older babies who are difficult to put to bed and/or who wake at intervals during the night need a fixed bedtime routine and, sometimes, a period of training in how to fall asleep by themselves and resettle themselves when they wake. Illness, changes in routine, and feeding problems can all affect a baby’s sleep temporarily.

See your doctor first

Arrange to see your doctor if:
● Your baby seems unwell or you are concerned about him or her in any way
● Your baby wakes up suddenly screaming and cannot be consoled

What you can do yourself

Try some or all of the following measures if your baby does not sleep well. Sticking to a routine with your baby and being consistent in your approach will bring results, although it may take time.

Babies up to 4 months
● Keep a sleep journal for a week, noting when and how your baby falls asleep and wakes. This will show whether there is a pattern to sleep disturbance and help you decide on strategies.
● Put your baby to sleep on his or her back, on a firm mattress with no pillow, toward the foot of the crib, so the bedding cannot cover his or her face.
● Check that your baby is not too hot or too cold. Keep the room at about 65ºF (18ºC) and don’t put the crib close to a heater. Don’t wrap your baby tightly. Cover him or her with one or two light blankets. Don’t use a quilt.
● When your baby wakes for a night feeding, keep the lighting low and change the diaper first or do not change it all unless your baby is very wet or has diaper rash. If your baby falls asleep at the breast or bottle, gently place him or her in the crib. Don’t make elaborate attempts to burp the baby or you may wake him or her up again.
● You may want to have your baby in bed with you in the early months, especially if you breast-feed, but be aware of the following precautions. You need a wide, firm bed and must lay the baby on the mattress (not on a pillow) with only a light blanket as a cover. Don’t sleep with your baby if you or your partner are smokers, have been drinking alcohol, or have taken sleeping pills or other drugs.
● Try to establish good sleep associations early on (see PRACTICAL TIPS, below). Carrying and rocking, or a ride in the carriage or car, will help settle a young baby between feedings during the day, but don’t use these methods continually or your baby may not be able to sleep without them.
● Encourage longer sleeps at night by establishing the difference between day and night. Keep the curtains open during daytime naps, and play and talk to your baby while you feed and change him or her. Keep the room dark at night and all stimulation to a minimum during and after a feeding.

Babies over 4 months
● Try to establish regular daytime naps because learning to settle and sleep in the day can improve your baby’s sleep at night. All babies under a year need two naps of an hour or more each day. Make sure the last nap is early in the afternoon so that it does not interfere with sleep at night.
● If your baby is over 4 months and gaining weight and feeding well, you can teach him or her to sleep better at night. A period of nighttime training using controlled crying or gradual withdrawal (see PRACTICAL TIPS, below) will stop your baby’s sleep problems becoming entrenched. Accept that if you have always comforted your baby promptly when he or she wakes, you are sure to feel anxious about this process at first.
● If your baby over 6 months has partial awakenings in which he or she cries briefly and thrashes around in the crib, check that your baby is well and resettle him or her. Keep a regular routine and prevent overtiredness to avoid the problem.

PRACTICAL TIPS

Establishing sleep associations
Using the same sequence of events every night will help your baby associate them with falling asleep.
● Bathe your baby at the same time each evening and make this a calm, quiet time, if possible, without too much stimulation and excitement.
● For a baby under 6 months, place the baby on his or her back in an airy crib. Stay beside the crib with your hand resting lightly on his or her chest and sing.
Stick to the same song every night since this will now become your baby’s sleep association.
● For older babies, sit by the crib spending time with your baby with a book or favorite toy and then settle your baby. Over time, a favorite soft toy, muslin
cloth, or blanket may become a transitional object that helps a baby to sleep. Some babies find their own thumb and suck it for comfort.
Transitional object When a baby begins to associate security and comfort with a favored blanket or soft toy, it becomes a transitional object.
Controlled crying You can use this technique to teach an older baby (who no longer needs to be fed during the night) to fall asleep by his or herself at bedtime and to settle again if he or she wakes during the night. You may find the process tough for the first few nights, but try to see it through.
● When your baby cries don’t rush in; wait for 5 minutes, then enter the room and say "good night" or "back to sleep now" (choose your own phrase). Then leave, even if your baby is still crying.
● Wait for 10 minutes before you return to your baby and repeat the phrase again in a calm, cheerful tone. Repeat the sequence again after a 15-minute interval,
then again after a maximum interval of 20 minutes.
● Now restart the procedure entering the room at 5-, 10-, 15-, and 20-minute intervals. Don’t give up if your baby continues to cry. Parents need to support each other through this process since most babies protest vigorously at first.
● Use the same technique consistently each night; it should begin to have an effect within 3–6 days.
Gradual withdrawal If you find controlled crying too difficult, try a separation technique called "gradual withdrawal."
● Place your awake baby in the crib, using your settling routine, and sit on a chair near the crib until your baby falls asleep.
● Every 2–3 days, move the chair a little farther from the crib until you are sitting by the door.
● Once you have reached this stage, try settling your baby and leaving him or her to fall asleep alone.
Learning to fall asleep Your baby may cry vigorously at being left for the first few nights, but if you maintain a consistent approach, he or she will learn to fall asleep alone and to resettle if he or she wakes during the night.