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How do I wean my baby off night feedings?
Q: From Lydia in Brasilia, Brazil
My 17-month-old daughter still nurses, which is not a problem during the day. However, she only sleeps at night when she nurses. When she wakes up at 2 a.m. the only thing that calms her is the breast. After that, I’m waking every hour to comfort her. Please give me some advice.
A:
Kristin in Raleigh
First, evaluate why your baby wants to nurse. Is it possible that she's making up for missed "Mommy time" or that she missed nursing time during the day? Some babies are so busy playing and exploring that they forget to nurse enough during the day and make up for it at night. There is good advice on how to handle the all-night nurser in "The Breastfeeding Book" by Martha and William Sears. It involves enlisting Dad's help in comforting, snuggling and helping baby back to sleep without nursing.

Bridget in Neosho
Try feeding table food to your daughter right before bed and then nursing her after. That's what I did, and it worked.

Laura in International Falls
We slowly weaned our daughter off the bottle/breast for night feedings. We replaced them with a watered-down version of milk and then with plain water. She lost interest and now uses a pacifier at night, which we're in the process of phasing out as well. Don't lose hope. She'll find a different way to soothe herself.

Barbara in Farmington
You have to let her cry it out for a few days. It is tough but necessary. My sister did what you did for her daughter until she was 2 years old, and the little girl had to have dental surgery because her teeth were damaged.

Christy in Atascadero
My twins were the same way, and I finally had to separate them and let them cry it out. I would go in a few minutes after they cried, then I spaced it out to 10 minutes after they cried and later 30 minutes. It took a little more than a month for the middle-of-the-night wakings to stop. It was difficult, but now the twin that woke up the most sleeps like a rock, so it was well worth it.

Karen Sokal-Gutierrez, M.D., M.P.H
Lydia, yours is a problem shared by millions of mothers around the world: how to help your child sleep through the night so you can get the sleep you need.

First, we need to understand why your daughter is waking up at night. Have the doctor check her to make sure she doesn’t have a medical problem that could be waking her, such as acid reflux, a food allergy, pinworms or an ear infection.

At 17 months, if your daughter is healthy and eating and drinking well during the day, she shouldn’t be hungry at night. The most likely reason she’s waking is that it’s become comforting to nurse and have you put her back to sleep. In fact, all babies and adults have natural sleep cycles with lighter sleep states and brief awakenings every one to two hours throughout the night. When babies learn to “sleep through the night,” they are actually awakening and putting themselves back to sleep.

Sleep experts say that the key to your baby learning to fall back asleep on her own is for you to put her to sleep for naps and at nighttime when she’s sleepy—that is, she’s fussy and rubbing her eyes—but still awake. If you want to continue to breastfeed your daughter during the day, consider shortening or cutting out breastfeeding before her nap and bedtime. You could nurse her briefly but stop nursing before she falls asleep, then put her down when she’s still awake. Alternatively, you could set up a different, comforting sleep routine without nursing. For example, at bedtime you could give her a warm bath or massage, read a book, sing a song and cuddle with her and a stuffed animal or baby blanket. Wear a bra and shirt to bed, and avoid holding her in the position and environment that you normally nurse her. Try to maintain a positive attitude about the change. Explain to her that she’s becoming a big girl now. Even though she may not talk much yet, she may understand a lot. Explain that big girls only drink milk during the daytime, when the sun is out, not at night. Give her lots of praise for being a big girl.

When you hear your daughter’s sounds at night, try not to immediately rush to comfort her. Children often make sounds in their sleep when they’re not actually awake. Wait a few minutes to see if she quiets down on her own. If she continues to cry, comfort her by talking, singing, shushing or patting her, but don’t pick her up and don’t nurse her. If you have other family members around—such as your baby’s father, your mother or your sister—ask them to help put your baby back to sleep. Some people can do this with the baby in bed with you, but others find it easier with the baby in a crib in your bedroom or another bedroom, or in bed with another adult family member.

Your baby may cry for the old nursing routine, and you may just want to give in and nurse her back to sleep. But try to be consistent and patient. Most parents find that their baby cries less and less each night, and learns to fall back asleep on her own and sleep through the night within a few weeks, and often within three to five days.

It can be difficult to make a change in your nighttime routine. But remember, you need to get a good night’s sleep to be a good mother during the daytime. Figure out what will work best for you, ask for help, try to be consistent and be patient. Hopefully, very soon, your baby will be sleeping better, and so will you.

Dr. Bettye M. Caldwell Ph.D. Professor of Pediatrics in Child Development and Education