A hungry baby wont sleep long. That means full feedings are the first step to a baby sleeping for a full nap or through the night. A full feeding for a newborn is considered 10-15 minutes per side, if nursing. As baby gets more efficient at nursing, timing is less important than other cues: empty breasts, enough wet diapers and poos (check with your ped on what is "enough"), baby stayed awake for the full feeding, baby appears satisfied after feeding, and baby is making it until next feeding time without problem.
{ total ounces per day } Babies 1-6 months old need an
average of 25 ounces of milk within a 24 hour period. If you're exclusively breastfeeding, you can determine how much your baby is taking per feeding by:
- Taking baby to a breastfeeding support group for a feed and weigh
- Pumping just before feeding time and seeing how much you put out to get an estimate of what you're capable of providing (this works best if your breasts "like" the pump)
- Feeding baby a bottle of pumped milk or formula to get an idea of how much baby takes at a standard feeding (works best if baby takes a bottle well)
I've done all three of the above with all my babies and gotten consistent results across all three, so I am then confident that what my baby takes from a bottle is similar to what they transfer during breastfeeding. If I'm ever questioning, I take my baby back to the breastfeeding group for a feed and weigh as that's truly the most accurate way to tell how many ounces a baby transfers in a feeding session.
Getting baby to sleep through the night requires that baby's stomach is big enough to get enough ounces per feeding during the day to hit that 25 ounces ballpark. Some examples:
- A 1 month old may take 3oz per feeding, thus requiring 8-9 feedings within 24 hours to get enough ounces per day. This requires feeding every 2.5-3 hours to fit 8-9 feedings in.
- A 3 month old may take 4-5oz per feeding, and thus only needs 5-6 feedings within 24 hours. Those 5-6 feedings could happen during the day (7am, 10, 1, 4, 7, and 10pm) and that baby may then be capable of sleeping through the night.
- A 6 month old baby may take 6oz per feeding, 4 times within 24 hours (about 4 hours apart during the day)
If baby is still waking to eat at night, the first thing to consider is if baby actually needs those ounces. If baby is under 10-12 weeks old, it's highly likely - almost without a doubt - baby still needs a middle of the night feeding to get all the ounces they need. Your job is to continue to push full feedings during the day so that baby soon wont need to eat during the night. Again, a breastfeeding support group that allows you to feed and then weigh your baby is the best way to determine how many ounces baby is transferring during a breastfeeding session. If you're bottle feeding this makes it super easy to tell how many ounces baby is taking per day.
{ day vs. night feedings } Day feedings should be happy, bright, and lots of eye contact. There should be much snuggling and smiling. This is a wonderful time to bond with your baby!
Night feedings, however, should be quiet, dark, and very little interacting. This is not social hour, this is time to eat and get back to sleep. It's okay to nurse directly to sleep for late evening or middle of the night feedings. As long as you're doing eat/wake/sleep during the day, nursing to sleep during the middle of the night will not create a bad habit. You certainly don't want baby having any wake time during the middle of the night! If you're going to do a diaper change at a night feeding, do it before the feeding so that there is no disruption if baby falls asleep while nursing. If baby poops while nursing, do change the diaper and then attempt to nurse just a little longer to get baby back to sleep. Around 8 weeks old, I stop changing baby's diaper at any night feedings. By 10 weeks old, I stop changing baby's diaper at the late evening feeding as well. Basically, baby will soon be sleeping through the night without a diaper change anyway, so no need for me to disrupt sleep by doing a diaper change now.
{ consistency } Some babies don't need rigid times, others do. I prefer not to gamble with this and simply be consistent from the start. If you've far been ballpark-ish with bedtime and morning feeding time but baby is having sleep issues, then locking down baby's first and last feeding of their day is the first step. Regardless of what happens in between those two feedings, you want morning feeding and last feeding of the day before bed to become consistent. You'll often see 6-7am as first feed of the day, and 7-8pm as last feed of the day; these are common first and final feed times for Babywise moms as those times generally allow for enough other feedings spaced thorough the day for baby to get enough ounces for the day.
Don't worry - life will not always be this rigid. The point of consistency is to be able to enjoy some flexibility from time to time. To be flexible, you have to have something to flex from. Just being willy-nilly isn't the same as being flexible; willy-nilly is simply being unpredictable. Babies and kids like predictability. As they are growing their whole world is naturally unpredictable, so you providing as much predictability and routine as possible is so, so comforting to them.
WAKE
{ wake time length } A well-rested baby will having sufficient energy to take a full feeding. Then, a well rested and well fed baby will have a happy and suitable awake time, after which they'll be ready for a full nap. Some babies have great sleep cues when they are ready for sleep, and others really don't have any. Sleep cues can include: crying, staring blankly, yawning, hand sucking, or general fussing. Other babies act like they are content to stay awake for hours, when in reality they should be put down to achieve enough day time sleep that they aren't overtired for nigh time sleep. An overstimulated or overtired baby will not sleep well. Some standard awake time ranges:
- 0-6 weeks: 30-60 minutes
- 6 - 12 weeks: 60 - 1hr20 minutes
- 12 - 24 weeks: 1hr15 minutes - 2.5 hours
- 16 - 28 weeks: 1hr30 minutes - 2.5 hours
- 28 - 52 weeks: 2 hours - 4 hours
Baby's awake time factors into how often baby is being fed during the day in that both wake time and ounces per feeding work together in tandem to help set baby's ideal schedule. For example, a 3 month old baby may be able to handle 6oz per feeding but that does not mean baby can be on a 4 hour feeding schedule because a 3 month old likely can't stay awake for the requisite 2 hours required in a 4 hour feeding schedule. A 3 month old can likely stay awake for 1-1.5 hours and then sleep for maximum 2 hours, landing baby on a 3 - 3.5 hour schedule. As long as baby can eat enough per feeding to make it 3-3.5 hours until the next feeding, then that's a great schedule. If baby can't eat enough, or can't stay awake long enough, feedings need to move closer together. If baby can eat more, and stay awake longer, then feedings can begin to be spaced out and/or condensed.
Check out my
sample schedules to what I've done with my kids.
{ stimulation level } Babies need some stimulation, and human interaction with mom or siblings is best for that, but do pay attention to baby's cues. Baby consistently looking away from you is a common indication that baby is done with face to face time. A baby in a very loud environment may become very still or rigid as they look around and take it all in, whereas a baby in a quiet room on a play mat may happily kick around and flap their arms while they "play".
As it is for adults, it's hard to go from massive stimulation right to sleep. You'll wan to consider the quality of awake time that baby had when putting baby down for sleep. What this looks like practically: if we've had visitors over and they've been coo'ing in baby's face for an hour, I know that baby has likely had more than enough face time and is totally "done". Baby might be extra fussy for that nap and have a hard time settling into sleep, so I would put baby in the swing for nap knowing that the gentle rocking motion would provide the extra help baby needs to settle into sleep. Thus, paying attention to baby's stimulation levels will help you better time baby's nap - and have grace for baby if they are struggling with their nap because of over-stimulation (common when there are older siblings around!).
SLEEP
{ sleep environment } The following are optimal sleeping environment considerations for a baby sleeping through the night:
- Dark room: Most babies benefit from near complete darkness, meaning blackout shades over the windows. At some point closer to toddlerhood, this becomes less necessary depending on the child and how well of a sleeper they become.
- White noise: A white noise machine or box fan will help block out house noises. There are so many options available for babies are toddlers, but for babies I would say nothing that projects light - just white noise. The "ocean" or "white noise" setting on most sound machines will be the most beneficial for baby. You want the sound machine close to the baby (not hanging off the door handle, for example), so put it directly under the crib or on a shelf near the crib (but never in the crib). A loud fan will also do the trick, just don't point it on baby. Also, check the air flow from the fan to make sure it's not blowing on anything in the room that will distract baby while sleeping.
- Separate space: To prevent against SIDS, the APP now recommends keeping baby in your room for first 6-12 months - so definitely use your own discretion on this next consideration. Baby sleeping in your room can result in baby waking when you get up to use the restroom, husband snores, toddler comes in from a bad dream, etc. Baby can also more easily smell you when in your room, so when they wake naturally in between sleep cycles the smell of you can trigger them to want to eat when they otherwise would eventually go back to sleep. You're also more likely to intervene with baby learning to self soothe if you're right there next to baby. Moving baby to their own room for sleeping is helpful to give baby their own space to sleep without distraction. Given the new recommendations by the APP, you need to decide what to do in this regard.
- Swaddle: most babies drop the startle reflex around 3-4 months old, so having baby sleep in a swaddle until that point helps prevent baby from waking when their arms involuntarily move during sleep (more on the swaddle in the third section).
Sleep is one area where I really encourage beginning as you mean to go. Before 6 weeks old, babies will really sleep anywhere. After 6 weeks, baby become more aware of when they are awake vs. asleep and thus you'll often notice a change in baby's sleep behavior around this time. I learned this the hard way with my first, so with my second and third I started putting them to sleep in their own crib within the first week. I would do a sleep routine too (see below), even though they totally didn't need it during the early weeks. I wanted the sleep routine to be associated with sleep, so I started it from the beginning.
{ sleep routine } Start this from early on, before baby even needs it. Even though a 1-week-old doesn't "need" a sleep routine to sleep, eventually that 1-week-old will be 6 weeks old and will start having a hard time getting to sleep as they becomes more alert/awake during wake times. Putting a sleep routine in place from the start will really help baby through development leaps that are often disruptive to sleep.
Our sleep routine for a baby looks like this: diaper change, swaddle, lights off, white noise on, sit in rocking chair on my lap facing out while I sing a song (same song every time). I then sit with baby until baby stop fidgeting, and then place the drowsy baby in crib on their back (with no blankets or pillows in crib!) and leave the room. You can read more about a sleep routine here.
{ sleep needs } Sleep begets sleep. A tired baby wont sleep well, or wont sleep well for long. Baby sleep needs do decrease over time, so staying on top of how many hours your baby needs is important.
- Overnight sleep: In general, babies need 10-12 hours of nighttime sleep, even if you're still doing late night of middle of the night feedings. A late bedtime almost always results in early morning wake-ups. It is common for babies to wake during the 5-6am hour and have trouble going back to sleep; don't let this become your first feed of the day! If you must, feed baby a small nighttime (dark, quiet) feeding and then put back to sleep until 7 or 8am, and then feed baby again and start your day.
- Naps: A successful nap is typically 1.5-2 hours (or 2-3 hours once baby is down to 1 or 2 naps).
The main point about sleep needs is that a well rested baby will sleep better than a tired baby. You want to teach baby how to sleep before you teach baby where to sleep. So if you're starting brand new at this, it's okay for baby to take naps in their swing, a carrier, a rock n' play, etc while you work on things like full feedings and implementing a sleep routine. You can work on moving baby to their crib at a later time. I'm a big fan of this sleep hierarchy from Val at Chronicles of a Babywise Mom.
{ how to sleep train }
The goal of sleep training is full naps and overnight sleep in their crib without intervention from mom or dad. If your baby isn't yet sleep trained, they will likely be doing one or more of the following:
- needing to be fed.and/or rocked completely to sleep
- waking 45 minutes into naps and not returning to sleep
- only sleeping in a swing, carrier, or bouncer
- waking to eat during the middle of the night past 6 months old
Before any sleep training is done, the following things should be in place:
- full feedings every 2.5-4 hours depending on age of the child (total average of 25 ounces per 24 hours)
- appropriate sleep environment: dark room, white noise, swaddle (if baby is under 3-4 months old), not co-sleeping
- set time for first and last feeding of the day
- pattern of eat, wake, sleep during the day
- a sleep routine
Let's start off at the sleep routine, as it is paramount to sleep training. The sleep routine works best when initially paired with successful sleep. So if baby will only sleep in a carrier or in a swing, do a solid 1-2 weeks of the sleep routine with baby still in the carrier or swing before attempting to move baby's sleep location. We want baby to associate the sleep routine with sleep, and that works best if baby is actually sleeping directly following the sleep routine.
The sleep routine is based on the 4 S's (
explained here on Val's blog). I wrote a separate post highlighting the
importance of a sleep routine, but I'll repeat the basics here. The sleep routine is something you do before each nap and bedtime to signal to baby it's time to sleep. The goal of the routine is to help the baby settle/become drowsy and thus prepare to go to sleep. The benefit of the sleep routine is that it brings baby to the brink of sleep but then allows baby to actually fall asleep on their own. This is the cornerstone skill that allows baby to take full naps or sleep through the night. If baby isn't reliant upon mom to actually fall asleep, baby wont call for mom when they wake naturally in between sleep cycles.
Our sleep routine looks like this:
- diaper change and sleep gear - can be jammies and/or sleep sack, swaddle, etc
- give sleep props (should you choose to use them) - paci and/or lovie
- lights out (it's okay to have the hallway light coming in for the sleep routine), white noise on
- sit in rocking chair and sing one song (same song every time)
- turn baby facing outward on lap and just sit together until baby is drowsy (no rocking, no talking)**
- place baby in crib sleepy but awake, close door
**This is the key step to the sleep routine. If you're doing this with your 0-6 week old, you'll likely have no problem as babies that age fall asleep without issue most of the time (which is why this is a great age to implement the sleep routine!). If you baby is older, this is the step that you will become annoyed with. Baby will likely fidget around and seem like they will never settle down. Be patient. Shhh baby if needed. Be more patient. Eventually, usually, baby will settle down and just kind of sit there. This is when you then move baby to their crib, set them down, and leave.
If baby is sleeping somewhere else other than the crib: still do the sleep routine, and then place baby in whatever place they are enjoying sleeping right now. We want them to associate the routine with sleep (just like they associate mom or a bottle with being fed - they are not too young for these associations!).
Sleep training is often synonymous with "cry it out (CIO)", but it really doesn't have to be. See, in reality, all moms sleep train their children. Some babies are trained that they need mom by their side to fall asleep, some are trained to sleep in a swing, some are trained they need a pacifier, some are trained to sleep on their own...you see? All children are trained - conditioned - to sleep in some way. So even moms that say they haven't sleep trained their kids have, in fact, sleep trained their kids - they just may have inadvertently trained them to sleep in a way that no longer works for the good of the kid, the parents, or both.
The aim of sleep training, as I'm explaining it here, is for baby to learn to fall asleep without assistance from mom. This not only helps baby go to sleep easier, but also helps baby to stay asleep for full naps and overnight sleep. All babies - and adults - go through sleep cycles when they sleep. A baby that is sleep trained still slightly wakes in between sleep cycles, but has the ability to put themselves back to sleep without assistance from mom. Learning to self-soothe during sleep is a skill, just like learning to nurse effectively (or even to take a bottle). It's a wonderful skill for baby to learn, but it takes some serious coaching from mom because it's a just that: a skill. And skills need to be taught and practiced and coached along the way. As a mom, you're going to spend a lifetime coaching your child on learning things they are capable of learning. It will be difficult int he midst of it, but the results will be well worth it. So this is as much a learning exercise for them as it is for you!
Here's what this looks like in practice: I'm picking up where I left off at the "sleep routine" section above. The sleep routine is to be done before every sleep session. Mom puts baby down and leaves the room. Baby cries. Mom waits 1-10 minutes depending on baby's age. Mom enters the room, picks baby up, shhh's baby (often releasing a burp), places baby back down, leaves the room, and waits again. Maybe mom waits longer this time, and then re-enters room. This time, mom pats baby on the tummy without picking baby up, shhhh's baby, leaves the room. Mom waits again, repeats. This continues until there is 45-60 minutes left in the desired nap time, at which point mom can move baby to whatever situation will help baby actually sleep before the next feeding (so swing, in mom's arms, wherever). Baby naps, eats, has wake time, goes down for next nap and the training begins again.
Regarding the amount of time mom waits between check-ins: I think this really depends on the age and demeanor of the child. If baby is single-digit weeks old, I think waiting just 1-2 minutes is enough time to see if baby will resettle on their own. If baby is 3-4 months old, I think 5-10 minutes is suitable. Some moms will find that going back in really just upsets the child more (two of my three were like this). Listen to the sound of the cry - this is where your mom instincts really come in. This is the part where mom is learning, too. Pause, really listen. Get to know your baby's cries. It's not abnormal for babies to cry or fuss a bit before transitioning to sleep. Any ladies out there ever feel like you need a good cry before bed some days? Babies, too, need to let off steam from their awake time sometimes. Not all crying is "bad" or needs to be tended to immediately.
If it helps, which is usually does, keep notes of how long baby is crying for, how many checks you do, etc - it's helpful to see if baby is making any progress. If baby is making progress, eventually you will see a baby that maybe fusses for a few minutes after being places in the crib and then goes to sleep. Baby make wake and fuss again midnap, and then return to sleep. Count those wins! If baby successfully goes to sleep at any point, that's a win! That's the ball connecting with the bat, that's riding a few feet without training wheels...practice makes perfect, but there will need to be ample time to practice this new skill before "perfection" is achieved. I didn't really understand how this worked until I had my second child. By default, I simply couldn't run in every time she cried. I often had to get my toddler secured with an activity so I could dart up to the nursery; by the time I got there, she was often already settled. So by default, I figured out what it really meant to give baby a few minutes to settle before intervening to help.
How well will your baby sleep train? I think it's equal parts nature vs. nuture. With my third, I really learned that some babies are just naturally predisposed to be good sleepers. It may be the confidence I've gained from the previous two, but I really think my third is just a natural born sleeper. I did - more or less - the same thing with all three kids and all three have responded differently to the same methods.
{ addressing common questions }
{ the "dream feed" } There is often confusion around the term "dream feed". In the 2012 release of the Babywise book, the dream feed is explained as a 10-11pm feeding that is offered past 16 weeks in effort to maintain mom's supply (but baby no longer needs it for their own caloric intake). Before 16 weeks, this feeding is just referred to as the "late evening feeding" and is offered as part of baby's necessary feeds. The confusion comes from the term "dream feed" also being used in a book called The Baby Whisperer (which I have not read); in this book the author refers to any late night feeding at any age as a "dream feed". This becomes a problem when a new mom is told to "drop the dream feed" if her baby is still waking at night, because up until 12-16 weeks the feeding between 10-11pm is still needed for baby's total intake and if not offered baby will wake to eat in the middle of the night to get those ounces in. My blog friend
Valorie explains this in detail on her blog. My point is this: up until 12-16 weeks, a feeding between 10-11pm (regardless of what you call it) is likely necessary for baby's total intake of ounces within 24 hour period.
{ waking up every 45 minutes } A common nap issue is waking 45 minutes into the nap (known as the 45 minute intruder). This happens because baby's sleep cycles naturally run in 45 minute intervals, so they are in a light state of sleep at the 45 minute mark. If baby thinks they need help going back to sleep because they are used to being rocked or nursed to sleep, baby will cry for mom to come provide this service for them so they can return to sleep. The point of sleep training is to help baby learn how to self soothe so that when they wake naturally during their nap they don't cry out and wait for mom to come put them back to sleep, they just do it themselves.
{ night feedings } Here is what we have done: if baby is under 5 weeks old, I feed baby at 10pm and then put back to sleep and let baby wake naturally to eat for the next feeding. The caveat to that, is I don’t let more than 4 hours pass between the 10pm feed and the next feed. If baby hasn’t woken to eat by 2am, I feed baby and put baby back to sleep, and then continue on every 2.5 – 3 hours from there.
Once baby is 5 weeks old, I then allow one 5 hour stretch between the 10pm feeding and the next feeding. At 6 weeks old, I allow a 6 hour stretch, 7 weeks/7 hour stretch, etc.
It’s not necessarily a “great” thing if your 5 week old is taking one long stretches at night without eating, because they’ve got to get those ounces in at some point. Going long stretches at night will likely cut out an entire feeding that they will make up for during the day with short naps because they are hungry and need more frequent feedings. Likewise, doing long naps during the day with long stretches in between feedings will result in a baby that wakes frequently at night to eat. Baby has got to get that 25 ounces average within 24 hours, and the best way to do that (for sleep purposes) is feeding every 2.5-4 hours during the day depending on age and how many ounces they take per feeding.
Okay, so say baby is still waking every 3 hours at night but I know baby could go longer: If I feed baby at 10pm and then baby wakes at 1am when I was hoping baby would make it to 2 or 3am, I will first give baby a few minutes to fuss and see if they are just transitioning sleep cycles. If still crying, I’ll go in (or send my husband in - because baby smells me and thinks "food!") and offer some other type of comfort first (paci, rocking) as a way of stalling and/or putting baby back to sleep. If baby is still obviously hungry, I’ll feed baby just enough to lure them back to sleep and then unlatch, place baby back in crib, and scurry out of the room. No diaper change, no unswaddling, no lights. Even if baby does need to eat, I’ve still then pushed the feeding time out upwards of 20 minutes depending on how long I stalled for. Eventually, if baby is getting enough ounces during the day, this method of “wait – stall – small feeding if necessary” will work to help baby drop feedings in the middle of the night. If you're totally sure baby doesn't need the feeding and is just waking out of habit, you can do cry-it-out, but I would save this for an older baby (4+ months) just to be really sure baby doesn't need the feeding.
{ reflux } There are many, many ways to handle reflux and your pediatrician can work with you on that. A reflux baby does not mean you need to abandon Babywise! The biggest thing you’ll need to figure out is how to sleep baby in a comfortable way. The
Rock 'n Play or
swing is just fine for now! Sleep do a sleep routine with baby, and then just place in the RNP/swing for nap. If you want baby in the crib, or baby wants to be in the crib, the best thing to do is elevate one end of the crib several inches (not the mattress, but the actual bottom of the crib). To prevent baby from sliding down while sleeping, take a hand towel and roll it up the long way. Slide it under the mattress sheet between the sheet and mattress, making it into a capital U shape. Snug baby’s bottom into the bottom of the U, so that baby’s legs are draped over the bottom of the U. This will help baby feel snug in the crib and prevent baby from sliding down from the incline.
If baby has reflux, it will be hard to get full feedings during the day – and that’s okay. Baby’s tummy being too full can make reflux worse. So take baby’s lead and finish the feeding when baby is clearly done. This may mean it will take baby longer to consolidate night feedings because baby will need smaller more frequent feeds (maybe every 2 – 2.5 hours instead of every 3 hours). Once the reflux is under control (through meds or diet changes for mom) then you can resume coaching baby to take full feedings during the day to maximize chance of baby dropping night feedings as the weeks go by.
{ pacifier } There are several types out there, so try a few. Also, if you want your baby to take a paci but they don't seem interested, keep trying. It can take days/weeks to get a baby to adapt to something new.
The paci is a great tool for delaying a middle of the night feeding (a paci will reveal if a baby just wants to suck for comfort or if they are actually hungry). The paci is also a great sleep association if you reserve paci for naps and nighttime only. The paci is also easier to take away (than a thumb) once baby is a toddler and it’s time to move on from it.
The negative of the paci is the dreaded paci game you have to play until baby is 6-7 months old and can put the paci in their mouth by themselves. Until then, you may often find yourself running into their room during naps and overnight to put the paci back in their mouth for them. For whatever reason, my 1st child only needed the paci to fall asleep and then didn’t care if he didn’t have it mid-nap or overnight. My 2nd though, she needed that thing in her mouth to sleep and it was not fun for us. My 3rd has been a thumb sucker and it’s been GLORIOUS because he’s barely needed any sleep training. My hope is to transition him to a paci when he’s 7-8 months old and get him off his thumb, because it will be hard to get him to drop the thumb habit when he’s older and I’d rather replace it with a paci habit and then take away the paci in a few years when it’s time.
{ swaddle } The swaddle is used to prevent baby’s moro reflex (the “startle” reflex) from waking baby during sleep. Baby is also used to being all snug in your womb, and the swaddle mimics that feeling. Baby naturally grows out of that reflex by 4-6 months old, but you don’t have to swaddle that whole time. Most mom’s swaddle baby until they start showing signs of being ready to roll back to front, or if mom wants baby to have their hands available for self-soothing. To drop the swaddle, you can do one arm out first (one of my kids loved that, two of them hated it) or go cold turkey no swaddle (my 2 boys preferred this). Or there are many swaddle transition products available, but we’ve never used any of those because really it’s just another thing you have to transition out of and I don’t like adding more work when I don’t have to. I usually swaddle my kids until around the 3-4 month mark. We use
these SwaddleMe pods the first few months (with
the double swaddle method). We then use
the SwaddleMe original next, and finally the
Swaddle Sleep Sack, before transitioning to a
sleep sack for the long haul.
If baby "hates" the swaddle, keep trying. Because what baby will hate even more than the swaddle is being unnecessarily awoken from her nap because of her arms startling her awake. All three of my kids needed to be
double swaddled to truly calm down, so consider that as well.
{ what to do now }
