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Your child is over 4 months of age and awakes and cries to be fed one or more times during the night. This behavior usually occurs every night and has been present since birth. Such a child is called a “trained night feeder.” The child is usually bottle-fed or breast-fed at bedtime until he falls asleep. When he awakens in the night, he is not tired; you and your spouse are.
From birth to 2 months of age, most babies normally awaken twice each night for feedings. Between 2 and 3 months, most need one middle-of-the-night feeding. By 4 months, about 90% of infants sleep more than eight consecutive hours without feeding. Normal children at this age (and premature babies who have reached 11 pounds) do not need any calories during the night to remain healthy.
If you follow the basic recommendations outlined below, your child’s sleep habits will usually start to improve within two weeks. The older the child, the harder it is to change her sleep habits. Infants over 1 years of age will vigorously protest any change and fight sleep through the night until they are 3 or 4 years of age, when busy daytime schedules finally exhaust them. By that time, of course, you’ll be exhausted too.
Gradually lengthen the intervals between daytime feedings to four hours or more. Nighttime feeding intervals cannot be extended if the daytime intervals are short. Gradually postpone daytime feeding times until they are more normal for your child’s age. If you currently feed your baby every hour, go to 1 ½ hours. If he cries, provide cuddling and a pacifier. It is important to provide your baby with periods of holding and cuddling separate from feeding times.
For every time you feed your baby, there should be four or five times that you snuggle him without feeding. When you baby accepts a 1 ½-hour schedule, go to two hours. The feeding interval will increase to three or four hours by four months of age when I start most babies on solids.
At naptime and bedtime, place your baby in the crib drowsy but awake. When your baby starts to act drowsy, place her in the crib. If she is very fussy, rock her until she settles down or is almost asleep, but stop before she’s fully asleep. If she falls asleep at the breast or bottle, it is best to awaken her. To help dissociate feeding from the bedtime ritual, consider feeding her one hour before bedtime or naptime. Her last waking memory needs to be of the crib and mattress, not the breast or bottle. She needs to learn to put herself to sleep. She will need this self quieting skill to cope with normal awakenings at night.
When your baby cries at naptime or bedtime, make brief contact every five to 15 minutes. Visit your baby before he becomes very upset and difficult to console. Younger or more sensitive infants may need to be checked on every five minutes.
Gradually stretch out the interval between visits. Make these visits supportive, but brief and boring. Leave the lights off, stay in the room less than one minute and leave your child in the crib; no rocking, playing or moving him anywhere. Act sleepy. Whisper, “Shhh, everyone’s sleeping.” This brief contact will encourage your baby to eventually go back to sleep.
When your baby cries in the middle of the night, rock her to sleep temporarily. Until your child learns how to put herself to sleep at naps and bedtime, make middle-of-the-night awakenings as easy as possible for everyone. If she fusses for less than five or ten minutes, respond as you would at bedtime. If she cries longer, take her out of the crib and rock her to sleep. Leave the lights off and keep her in the room. Stay quiet and act tired.
Feed your baby only once during the night. After the last feeding of the day-usually between 8 and 10 p.m., depending on your baby’s age- feed him only once during the night and only after four or more hours have passed since the last feeding. Make this nighttime feeding brief and boring. If it takes more than 20 minutes, you are handling or burping the baby too much.
Eventually, phase out the last nighttime feeding. Do this only after the intervals between daytime feedings are longer than three hours AND your child can put herself to sleep without feeding or rocking. Gradually reduce the amount you feed your baby at night. For bottle-fed babies, decrease the amount of formula you give by one ounce every two to three nights. For breast fed babies, nurse on just one side and for two minutes less every two to three nights. After one or two weeks, your infant will no longer crave food at night. You can also expect your child to return to sleep without holding or rocking after nighttime awakenings.
Do not put a bottle in your baby’s crib. You can avoid this problem by feeding your baby an hour before naptime or bedtime, as mentioned earlier. If you feed him at bedtime, you hold the bottle. If he needs to suck on something to help him go to sleep, offer a pacifier or help him find his thumb. Thumb sucking is a natural, soothing drive at this age. Also, feed him some place other than the bedroom. Try to separate mealtime from naptime or bedtime.
Help your child attach to a security object. A security object, such as a cuddly stuffed animal, soft toy, doll, or blanket, can provide a source of reassurance and help your child separate from you. Sometimes covering a stuffed animal with one of the parent’s T-shirts helps the child accept it. Include the security object whenever you cuddle or rock your child during the day. Also include it in the bedtime ritual by weaving it into your storytelling and tucking it into the crib next to your child. Eventually, she will hold and stroke the security object at bedtime in place of you. Do not keep the crib in your bedroom, if possible. If the crib is in your bedroom, move it to a separate room. If this is impossible, cover one of the side rails with a blanket so your baby can’t see you when he awakens.
Eliminate long daytime naps. After your baby has napped for two hours during the day, awaken her. If she is in the habit of taking three naps during the day, try to change her habit to two naps a day by delaying the first nap.
Leave her in the wet diaper overnight. Change the diaper only if it is soiled or you are treating a bad diaper rash. If you must change your child, use as little light as possible (a flashlight, for example), do it quietly, and don’t provide any entertainment.
If your child won’t lie down in the crib, leave her in the standing position. Try to get her to settle down and lie down. If she refuses or pulls herself back up, leave her that way. She can lie down without your help. Encouraging her to lie down soon becomes a game.
Keep a sleep diary. Take note of the time your child awakens in the morning, when and how long he naps during the day, and what you did to put him to sleep. At bedtime, record the time he went to sleep, how long it took, and what you did. For each time your child awakens at night, record the time, how long he was awake, and what you did. Bring the diary to the next visit.