Q&A with a Certified Pediatric Sleep Consultant: Part II
Katie Pitts, Certified Pediatric Sleep Consultant from Sleep Wise Consulting stopped by the Milkful Facebook page on January 16th to answer baby, toddler and child sleep questions from our Milkful mommas.
Read what questions they had to ask her, and how she recommended they approach sleep issues. You can also read her advice from our first Q&A in December.
Teaching Sleeping Skills to a 4 Month Old
Angie: I have a 4 month old boy. We have the same routine every night. It starts at 8 with a wipe down or bath, diaper change, jammies and nurse and then he is tucked into his bassinet. He usually falls asleep while nursing but as soon as he is in his bassinet he screams and cries. I used to pick him up and try to nurse again but recently started letting him cry it out which isnt working either. He usually winds up going to sleep between 10 and 11 but then is up every 2 hours after that. What can I do?
Katie: Sounds like a frustrating start to your evening. The reason many people say "cry it out" doesn't work is because CIO can be like a Band-Aid and until you fix the underlying cause and reasoning for the wakings, the crying won't get better! Try switching up your bedtime routine to wipe down/bath, diaper/PJs, nursing (keep awake) and then book. If you put him in the bassinet awake, he will have a much better chance learning his own sleep skills versus if you put him in already asleep and then he wakes and gets a second wind! At times, an 8:00 pm bedtime can be too late for this age so if he already seems tired, try bumping it up to 7:00 or 7:30.
Turning a Hot Mess Sleeper into a Good Sleeper
Cherie: My two-year-old stays up late no matter what we do. He does not nap during the day, and at bedtime when we shut off the lights and turn off the electronics he fights us on laying down. He will scream and walk the house and mess with the dogs! We have always co-slept with him and would like to get him on a sleeping schedule so that we can get him in his own bed. My seven week old is completely backwards. He is up early in the morning, then sleeps during the afternoon until 6 p.m. and then is up until we get our two-year-old calm.
Katie: Sounds like you have a lot happening at your household! Let's start with the toddler. If he won't nap, then he is going to need a VERY early bedtime. When you see him turn into a hot mess, it means he is overtired. Depending when he wakes in the morning, you will want him in bed 11-12 hours later. If he wakes around 7:00 am, then he needs to be in bed around 6:00 or 7:00 pm. Using a clear reward/consequence chart to keep him in bed can be very helpful. With your newborn, having a bedtime routine is the best way to help him organize his days and nights. Babies this age need 12 hours of sleep so whenever you want morning to begin, wake him to start the day and then make sure he is in bed 12 hours after that.
Knowing When it is Right to Move an Infant into Their Own Room
Emma: My son is barely two months old. He is rooming in with us at night (which I absolutely love and would like to do as long as I can), and he usually wakes up every couple hours or a little longer to nurse and then goes right back to sleep. I wanted to ask you when it is recommended to move him to his own room, or how I can know it’s time for that? Should we do any kind of sleep training for the transition? Is there anything we should be doing even this early on to help prepare for that future transition? Any recommendations/tips would be so appreciated! Thank you so much!!
Katie: You can move him to your room whenever you are comfortable! The AAP recently came out with recommendations to leave a baby in your room until 12 months old and other experts have argued that up to 6 months in appropriate. I personally could not sleep well when my newborn was next to me because he was such a noisy little sleeper so if it's working for you, it's okay to keep it! When you are ready for him to move, you will know ￼:) The best tips I have for you right now is to work on putting him down awake at bedtime and for naps. This won't happen 100% of the time and that's okay but the more opportunity he has to learn his own skills, the better sleeper he will be! This does NOT mean to let him cry. I don't recommend any crying at this age but many times, if you feed a baby and lay them down, they surprise you and put themselves to sleep!
When a Good Sleeper Turns Problematic
Alyssa: My daughter is currently five months old, and will be six months on January 30th. She was sleeping through the night, but lately she wakes up at all times of the night. She is not consistent with them at all. The only way I can calm her is to let her nurse and she will do this for 10-20 minutes. She takes two naps usually during the day. She was napping great we were at the point where we could lay her down when she showed us sleepy signs and she would go right to sleep, but recently she cries and we have to go in three or more times to get her to go to sleep. I'm just wondering why she has been so all over the place lately and fighting sleep so hard again.
Katie: Great job on establishing some wonderful independent sleep skills. It sounds like your little girl might need a schedule change. A typical routine at this age is to nap 2-3 times per day (napping twice a day if naps are at least 1.5 hours) and then being awake for 2.5 - 3 hours before bed. Naps should be approximately 2 hours apart. Try this schedule change and see if it helps!
Transitioning a Toddler Away from Co-Sleeping
Diana: My son is 16 months and sleeps with us in the bed and still nurses. He has only slept through the night once or twice in 16 months! I’m not sure how to get him transitioned to his crib to sleep through the night. He has fallen asleep in his crib before but only with back rubs and holding my hand. How can I transition him without the intense crying?
Katie: Falling asleep in the crib with back rubs and hand holding is an excellent start! I would stay really consistent to teach him that mom will be there for him and comfort him, but he has to sleep in his crib. Eventually, once he gets better at this, you can try weaning out your support. If he nurses in the night, make sure he stays awake during the feed and he is still falling asleep in the crib.
Lengthening Time Between Night-Time Feedings
Kaitlin: My five and a half month old son is still up every two hours to comfort nurse or eat, but when he eats it’s only about an oz. I give him expressed milk in a bottle￼. How do I get him to give mommy at least a 4-5 hour stretch!? We go to bed around 7:30 and sleep until 10 p.m., then are up every two hours until 6:30 a.m. Am I just sensitive and waking up to his every noise? I’m not sure what to do! But 6+ months of no sleep is starting to take a toll! I do try and give him his oatmeal for dinner so he gets “full” but doesn’t seem to make a difference, neither does sleeping with me, next to me, or in the crib!
Katie: Not sleeping night after night can feel like pure torture! It sounds like your little boy is relying on nursing or bottle-feeding as a prop. A sleep prop is anything external a baby uses to fall asleep and stay asleep. This can be nursing, rocking, bouncing, etc. When they do not know how to fall asleep on their own, they will wake many times throughout the night (as we all naturally do) and need help falling back asleep with that prop. It becomes frustrating because they wake even when they are not hungry! The best way to have longer stretches as night is to put your baby down 100% wide-awake at bedtime. If he wakes in the night, it's okay to offer a feed but work on keeping him awake.
Understanding a Shifting Sleep Cycle
Ciara: Why is my daughter waking up twice before midnight? Why does she want to nurse so much from 4 a.m. to 6 a.m.? She is 14 months old, still breastfeeding to sleep and during the night but not during the day. Typically she falls asleep between 7 & 7:30 p.m. in the crib and we have to wake up at 6 a.m. to begin the day.
Katie: So it sounds like your daughter has some of her own sleep skills since she can do this during the day which is great! This is really going to help you at night. Start working towards putting her down in the crib awake at bedtime. If she falls asleep while nursing at bedtime, when she wakes to shift sleep cycles (which is a natural thing to do), instead of drifting right into the next sleep cycle, she will need your help getting her to sleep with however you got her to sleep in the first place! Nursing is absolutely still okay in the bedtime routine but the goal is to do it for nourishment and allow her to find her own ways to sleep!
What to Do When Baby Won’t Sleep On Their Back
Olivia: My daughter is three months old and absolutely hates (I mean hates) to sleep on her back. We’ve been struggling a lot with getting her to sleep on her back and by herself at night. Are we doomed at this point? Will she ever be able to sleep in her own crib or have we already set bad habits? I don’t like the idea of “cry it out.” She only wants to nap in a baby sling on my body during the day, and has to be on me at night. If those two things happen, she sleeps great! ￼But obviously this is not ideal or sustainable.
Katie: That sounds like my son at this age!! The good news - there is a solution but it can be quite a bit of work to get there. I'm with you that I don't like the idea of "cry it out" at this age either. Crying advice goes much beyond this Q&A (as it typically takes me 60-90 minutes in a phone call to explain) but my best tips for putting him down on his back in the crib are to watch your awake times (make sure he is going down for bedtime no longer than 1.5 hours since he woke from his nap) and have a calming bedtime routine where he is relaxed at the end, but not asleep.
Establishing a Schedule with a Child Who Hardly Sleeps
Ashley: My little one is 15 months and hardly sleeps. She has dark circles under her eyes yet she fights a lot to go to sleep. I usually wake her up by at least 8:30 or 9 and she will take a 30-minute to an hour nap during the day but she only sleeps around three hours per night.
Katie: Your poor little girl (plus mom!) must be exhausted. I would start with trying to get her on some type of schedule. Most babies this age wake around 7:00 am, take a nap from 12:00 - 2:00 and then go to bed around 7:00 pm. She sounds like her circadian rhythm is set a little later so I would start with waking her at 9:00 am, doing a nap from 2:00 - 4:00, and then putting her in bed around 9:00 pm. If she only takes a 30 minute nap, you will want to put her in bed much earlier, around 7:30 or 8:00 to prevent over-tiredness.
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