What Causes Nighttime Awakening?

All children, especially during the first year of life, may awaken several times each night following dreams, but most can put themselves back to sleep. The ones who have not learned how to do this cry for a parent. If you provide too much attention (constant rocking, for example), the infant becomes dependent on you for returning them to sleep. If you play with the baby at these hours, the child may decide to have this kind of entertainment every night. These infants are known as trained night criers. The infants who demand to be fed as well as held are called trained night feeders. After 6 months of age, the normal separation fears of many infants are accentuated at bedtime and during the night. These children become fearful night criers. Changing diapers during the night, allowing excessive daytime naps, and sleeping in the same room with the baby can contribute to all three types of sleep problems.

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Trained Night Feeders

If your baby is fed during the night, deal with this problem first. From birth to 2 months of age, most babies normally awaken twice a night for feedings. Between 2 and 3 months, most need one middle-of-the-night feeding. By 4 months of age, about 90% of infants can sleep more than eight consecutive hours without feeding. The remainder can learn to sleep through the night if you take the following steps.

1. Increase the daytime feeding intervals to four hours or more.Nighttime feeding intervals cannot be extended if the daytime intervals remain short. The baby's stomach is conditioned to expect frequent feedings and complains if they are delayed. Gradually postpone feeding times until they are more normal for the child's age. Your goal is four meals per day by 4 months of age and three meals per day by one year. The infant's demands for unnecessary feedings can be met with extra holding, attention, or a pacifier.

2. Discontinue any bottle in bed immediately. Feed your child at bedtime, but don't let him hold or keep the bottle. If he has increased sucking needs, offer him a pacifier or help him find his thumb.

3. Phase out night feedings. Keep in mind that normal babies over 4 months old (and premature babies who have reached 11 pounds) do not need any calories during the night for health reasons. Once the daytime intervals are normal, nighttime awakening will probably decrease or disappear spontaneously. In the meantime, when your baby awakens at night and appears hungry, feed him but leave him slightly hungry. For bottle-fed babies, the amount can be decreased by one ounce every few nights until your infant no longer has a craving for food at night. For bottle-fed babies, the amount can be decreased by one ounce every few nights until your infant no longer has a craving for food at night. For breast-fed babies, nurse him on just one side.

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With these measures, improvements should occur in about two weeks. It is important to start correcting the problem as early as possible. The older the child is, the harder he is to treat.

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Trained Night Criers

If your baby does not awaken for food but still has nighttime crying, respond briefly or not at all. Crying is not harmful, and infants cannot get over this problem without some crying. When your baby awakens and cries, wait at least five minutes before going in the room. Infants should be taught to use their own resources to get back to sleep.

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If the crying continues, you go in, but don't stay longer than one minute. Act sleepy, whisper "Shh, be quiet, everyone's sleeping," add a few reassuring comments, and give some gentle pats. Do not turn on the lights or remove him from the crib. Absolutely avoid rocking or playing with the baby, bringing him to your bed, or staying in the room for more than one minute. Most young infants will cry for 30 to 60 minutes and then fall asleep. If the crying persists, you may recheck your baby every 15 to 20 minutes, for one minute or less each visit, if you feel it is necessary.

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Fearful Night Criers

If your child sounds fearful, panics when you leave, cries until he vomits, or by past experience will cry nonstop for hours, go in immediately and reassure him. Stay as long as it takes to calm him, but don't lift him out of the crib. At the most sit in a chair next to the crib with your hand on his body. Don't talk much and leave the lights out. Leave for a few minutes every now and then to teach your child that separation is tolerable. Do the same thing at naptime and bedtime.

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For separation fears, using the night-light (to offset fear of the dark) and leaving the bedroom door open (to offset the fear of the parent being gone) are always important. During the day, respond to the child's fears with lots of hugs and comforting. Young babies may need more time being carried about in front sling or backpack.

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Children of working mothers especially need undivided time and cuddling in the evenings. Also practice separation games like peek-a-boo, hide-and-seek, or chase me.

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Steps to Take For All Types of Sleep Problems
Whether your baby's problem is trained night feeding, trained night crying, or fearful night crying, the following measures should be helpful.

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Put your baby to bed when he is awake. Many trained night feeders and criers are rarely ever placed in their cribs awake. If your baby goes to sleep in your arms occasionally, that's fine. But try to place him in the crib awake for bedtime and all naps. His last memory should be of the crib, not you or the bottle.

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Move the crib to another room. If the crib is in your bedroom move it to a separate room so you aren't awakened by your baby's normal tossing and turning. If this is impossible, cover one of the side rails with a blanket so your baby can't see you when he awakens.

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Eliminate long daytime naps. If your baby has napped for more than three hours, awaken him. If he is in the habit of taking three naps per day, try to convert him to two.

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Don't change diapers during the night. Babies can survive until morning with a wet diaper. The diaper can be changed if soiled, although this is uncommon. It also may be changed if you are treating a bad diaper rash. If you must change your child, use a flashlight, do it quietly, and don't provide any entertainment.

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When to Call for Help
Call this office during regular office hours if you feel the crying has a physical cause, if your child acts sick, if someone in your family cannot tolerate the crying, or if the steps outlined here do not produce improvement in sleep habits within two weeks. Feel free to contact us if you need additional information on sleep problems.