‘My 20-week-old baby is not sleeping and I’ve tried everything’

Question: My little boy was a great sleeper from birth – he slept six hours straight a night until six weeks. He then got sick and screamed every night for two weeks before he was good again. He never went back to sleeping for six hours but when he woke I could easily settle him back to sleep. Then when he passed 16 weeks it all became really difficult.

First it is hard to get him to fall asleep and then he wakes several times through the night. I've tried various things: putting him in the cot awake to encourage him to settle himself; giving him a soother for bedtime; having teddy in the cot; and using gentle music and white noise, but nothing is really working. The only way I can get him to sleep is to breastfeed, he will fall asleep in my arms and I can pop him into the cot. But of course then he's  awake several times during the night. Last night at 1am I was so exhausted  I kicked my husband out to the spare bedroom and the baby slept perfectly well in bed with me for five hours.

But I can’t keep doing that and I want him to settle in his cot.

Any advice to get him sleeping well again? He is 20 weeks old today. 

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Answer: The journey to having your baby sleeping consistently through the night is usually a long one. Many parents like yourself have an initial good start with their infants sleeping long periods overnight, though this does not guarantee that this success will continue. For babies under four months, their sleeping patterns are largely determined by their feeding patterns. Babies are programmed to wake up when they are hungry and some babies can last up to six hours or more without feeding at night especially when they have a good last feed. Four months is usually a significant milestone as most babies can go through the night without needing a feed at this age. They may still awake during the night (and most children usually do), but if you are lucky they learn to self-soothe and get themselves back to sleep. The problem arises when they are dependent on the comfort of being fed to get themselves back to sleep. If breastfeeding has become part of their ritual of falling asleep at bedtime, this is often what they will seek when they awake during the night.

Helping your baby get back to sleep by himself

The goal of sleep training is to teach your son how to self-soothe and get himself back to sleep during the night. You want to break the link between breastfeeding and falling asleep. The best place to start this sleep training is during the day, in particular during the bedtime and nap routine (rather than during the night when everyone is stressed and tired).

As you have been trying already you want to create new positive sleep associations that help your son get to sleep. The key is to feed him before the last stages of the bedtime routine, maybe even outside the bedroom. Then you put him down in his cot, when he is tired but not fully asleep so he takes the last steps of falling asleep by himself. If he cries or can’t settle, try to comfort him with minimal support from you. For example, you pull back for a few minutes to see if he can settle himself, or you might pat him while he is still lying down or use music or offer him a soother etc (different things work for different babies). If you do have to lift him to comfort him, avoid feeding him and use other soothing tactics to settle him. Once again the idea is to place him back in the cot before he has fully fallen asleep so he takes these final steps himself. Sleep training like this takes patience and persistence.

Dealing with night-time waking

Night-time waking is stressful for parents and babies. It is hard to be consistent at night when you and baby are over-tired. You can of course repeat the bedtime training at night and sit beside the cot supporting your son to go back to sleep by himself, but it is okay to change the rules slightly and do whatever works to minimise the disruption at night. Lots of parents take the baby into their bed during the night to help him back to sleep. Other parents lie with their babies beside the cot or bring the cot close to their bed. Once you work on keeping the bedtime routine consistent, it can be a case of anything goes at night. Find the easiest way to manage and to get your baby back to sleep.

Sharing the burden

Getting children to sleep at night can be stressful and it is usually a good idea to share this job between parents. Could you alternate the bedtime routine with your husband? You can agree a relaxed bedtime routine for your son in advance that either of you could implement. This would give you a much-needed break on your nights off and give your husband the satisfaction of being involved and managing. You could also take turns dealing with the night waking. It will be good for baby as well as for you to have his father being involved at this level.

A note about over-tiredness and naps

One of the big problems about sleep problems is over-tiredness. If babies are constantly waking at night they (and their parents) become over-tired and stressed, this makes it harder for them to fall asleep. As well as responding at night, it is important to ensure they sleep well during their nap times during the day. Babies who have a long nap early on during the day tend to sleep better at night. Further if you can establish a nap routine that is similar to the bedtime routine (not linked to feeding etc) then this helps them learn to self-soothe and settle. A relaxed daytime nap routine, helps create a relaxed bedtime routine and will reduce night waking.

– John Sharry is founder of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books including Positive Parenting and Parenting Teenagers. See solutiontalk.ie for details of courses and articles.