Preventing Sleep Problems

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Newborns have irregular sleep patterns, but by two to three months of age, your child should be on a more regular schedule. It is important to provide a consistent routine for your child, including a bedtime routine, which consists of all of the things that you do to help get them ready for bed, and can include quite playtime, a last feeding, reading a book, taking a bath, changing their diaper, etc. This should also include developing good sleep associations, which are the things that your child associates with falling asleep, including falling asleep alone in their crib. It should not include falling asleep while nursing or drinking a bottle, sucking on a pacifier or being rocked, since if your child wakes up in the night, he will need those same conditions to go back to sleep.

By three months, the majority of babies are able to sleep for most of the night, but may wake up again in the middle of the night. The babies that have developed good sleep associations are able to go right back to sleep, while the ones with the wrong associations cry out. The best way to develop healthy sleeping habits is to have a good bedtime routine and to put your child into their crib while they are drowsy, but still awake, with conditions that they can re-establish for themselves if they wake up in the middle of the night.

To make this easier you may give your child a special stuffed animal, toy or blanket, or help them find their fingers to suck on when you put them to bed. Try to incorporate this ‘transitional object' into the bedtime routine (for example, have them hold their blanket while you are reading to them before bed). Avoid letting your child fall asleep with a bottle, since the milk or juice will coat their teeth all night and promote cavities or using a pacifier at bedtime, since if it falls out while they are sleeping, when they wake up they will cry out until it is replaced. The biggest mistake that most parents make is allowing themselves to become the ‘transitional object' with which child has learned to fall asleep.

If your baby has not learned the proper sleep associations by the time he is five to six months old and he is waking up one or more times during the night, there are ways to help your child learn to sleep through the night. The most popular method is that taught by Dr. Richard Ferber, which advocates that at bedtime you put your child in his bed while they are drowsy, but still awake, and help them learn how to fall asleep on their own. It is recommended that you start the training at a time when you can afford to lose some sleep for up to a week and that you be consistent during this time. If at any time during the training you give in and let your child fall asleep in your bed or while drinking a bottle, then you may have to start all over. Most children show improvement in a few days, and will be sleeping through the night in a week or two.

To begin, you will need to develop a bedtime routine that will end with you placing your child in his bed to fall asleep on his own (with his transition object). The Ferber method is a ‘progressive approach' in which you allow your child to ‘cry for gradually longer periods of time before returning to him briefly.' The first night, after placing your child in bed to fall asleep alone, you should leave the room and allow him to cry for about five minutes. If he is still crying after that time, you can return to his room to reassure him that you are still there. You can speak to him briefly and pat his back a few times, but avoid picking up or rocking your child. After two or three minutes you are to leave the room again (even if he is still crying). If your child continues to cry now for ten minutes, you can again return to his room briefly for reassurance, but be sure to leave after two or three minutes. If she is still crying after fifteen minutes you can return again, and the rest of the night wait for a maximum of fifteen minutes. Your child will probably fall asleep during one of these fifteen minute periods. If your child wakes up again during that first night, you can use the same method of letting him cry for five, ten, and then fifteen minutes. The next night you will start off by waiting for ten minutes and increasing by five minute intervals to a maximum of twenty minutes. Each night, you will increase the ‘First Wait' by five minutes. For example:

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