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Children's Health

My 5 month old will not sleep at night

02/16/2009

Question:

At 4 months of age we began a night time routine for our baby boy. He will fairly easily go to bed around 8 pm. But he regularly wakes at night, 1, 2, sometimes 3 or more times. Waking once an hour or two. After he cries for a bit we try to sooth him, but do not remove him from the crib unless we think he may need a diaper change. If he does we change him without much interaction and put him back to bed. He sleeps on his stomach. It is the only way to get him to sleep, but when he fights it he flips himself over and will cry indefinitely until we go put him back on his tummy and to sooth him. Eventually, sometimes after several attempts over an hour or two, he will fall asleep to our soothing, but sometimes wakes up an hour or two later. He will of course take my breast if I offer it, but as you have said to other parents, they should be able to sleep through the night without that need so we stopped that a while ago. We are all suffering and I have to go back to work in three weeks and don`t know how I am going to function with an infant still waking so often and for such long periods. I should mention that he is also on a regular nap schedule during the day taking two to three 1-2 hour naps a day. HELP!

Answer:

This is most certainly a vexing problem many parents endure. If your baby was a full term, healthy baby boy, then you need not have any concern about stopping night feedings or about your infant's readiness to sleep through the night. However, be aware that no child permanently sleeps through the night in the first several years of life. It is quite common for children who have been sleeping through the night to starting waking again, particularly if there are changes in the home or if he or she is in a big period of developmental change. The best advice is to stick to your guns with the routine and limits you have used before the child started night waking again.

You have found a possible solution already, which is to set a limit and stick with it. That was in regard to breastfeeding at night, you determined it was time to stop it and you did so successfully. So now, you have one more component of the night waking habit to eliminate, the parent coming back to comfort the child. Basically your son has learned to rely on a parent to help him sleep. You are his sleep habit. In contrast, what you want him to do is learn how to self-soothe himself to sleep. This is an appropriate skill for him to master at 4 months for his own sake in learning self-regulation  and for your sake so that you can perform well at work and as his parent with adequate sleep.

Part 1: Keep the pre-bedtime period mellow and low key. Maintain your bedtime routine, put him to bed awake or drowsy but not sound asleep, and make sure he has a security object (A soft stuffed animal, blanket or doll you always hold to comfort him and then leave with him at bedtime. Small sizes are good so there is no chance for suffocation. Several duplicates are also good so that you have  back up when the current one needs cleaning or is lost or left behind at grandma's house.). Security objects remind the child of your loving presence and comfort him in stressful times. It might take a week to get this bond between child and object set. Now it is time to move Part 2 of your plan.

Part 2: Option 1: Decide what period of time you will tolerate  him crying before you give reassurance and stretch this out progressively. Start with 10 minutes the first night, then 15, then 20, then 30. Hopefully that is the end of it. You can stretch the time every other day. Keep on making diaper changing, if you do it, as boring as possible.
 
Option 2: You and your son go cold turkey. You steel yourself not to go in at all and let him cry it out. Some parents feel better having a videocam in the child's room so that they can observe the child and know their child is fussing but OK.

There is no one single way that works for all parents and all babies. choose the approach you are most comfortable with. What I do know is that you are not being mean, your child will not hate you or hold it against you, and he will learn an important skill. You do not want to breakdown and go back to the old routine. That is a more powerful reinforcement for retaining the old behavior; better than punishment or positive reinforcement.

The American Academy of Pediatrics offers a good book on promoting your child's sleep entitled Sleep Problems in Children and their are numerous books in the parenting section of book stores. two popular books currently are No Cry Sleep Solution by Pantley and Sears and the Healthy Sleep Habits, Happy Child book by Weissbluth.  The National Sleep Foundation website also has advice for parents, www.sleepfoundation.org.

It will not be easy to solve the problem for parents or baby, but it is better to tackle the problem now rather than later. I hope this helps.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University