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Sleep struggles with a 4-month-old
Q: I'm having a difficult time getting my 4-month-old to sleep. She begins the night in her cot between 9 and 9:30 p.m. She usually wakes for a feeding between 12:30 p.m. and 1 a.m., at which time I nurse her. I generally fall asleep with her at the breast, but when I wake to put her down, she wakes up. This cycle continues about every three hours. How can I help her learn to sleep in her cot after breastfeeding?
Tamela St. Petersburg
A: Tamela, this is one of the most common concerns that parents have—how to help your baby, and you, sleep through the night.

In the first few months of life, babies need to feed every few hours, including at night. But by 4 to 6 months of age most babies have the stomach capacity to hold them through the night. This means that if your baby eats enough during the day, she shouldn’t wake up at night because of hunger. Although it might seem that she’s hungry when she wakes up and nurses, nursing at night is probably more for comfort.

Then why does your 4-month-old wake up every three hours? Babies have natural sleeping cycles that bring them into lighter levels of sleep every three hours through the night. Although the expression “sleep like a baby” implies that babies sleep soundly through the night, they commonly awaken several times during the night and fall back to sleep.

Here are some tips to help your baby learn to sleep through the night:
  • Try to show her that daytime is for being awake and nighttime is for sleeping. During the day cuddle her, play with her and take her on walks outdoors. If she takes a nap for more than three hours, wake her up gently to play some more and eat. This will help her save her longer sleepy period for nighttime.

  • Be sure that she’s eaten enough during the day and before bedtime. It’s great that you’re breastfeeding. That’s the best food for your baby. In addition, when she’s between 4 and 6 months of age, you can start giving your baby cereal mixed with breast milk and pureed vegetables and fruits. Look for signs that she’s ready: she reaches out to food, has good head control, doesn’t thrust her tongue too much and is able to swallow well. Make sure she’s had a good meal in the evening and consider nursing her before bedtime.

  • When you put her to sleep at night, have a special bedtime ritual such as a bath, a book, a song and a kiss before lights out. The bedtime ritual should be different from naptime, and eventually she’ll learn that this means goodnight—for the entire night.

  • When she wakes up every three hours, help her learn to put herself back to sleep. Give her a few minutes to see if she’s just fussing a little and can, in fact, put herself back to sleep. If she continues to cry, check on her. It can be helpful to have dad rather than mum do it, since she’ll want the breast when she sees you. But don’t turn on the light, pick her up or feed her. Reassure her in a soft voice or pat her gently, then leave. You can continue this pattern of waiting and checking until she falls asleep. At first it might be difficult to listen to your baby cry, but if you’ve ensured that she’s okay, try to stick to the plan. Your consistency will help her and you. Each night, extend the amount of time you wait until she learns to settle herself back to sleep. For many babies it takes only three days of consistent waiting and checking. For others it takes a little longer.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician