Just when you’ve gotten used to a little bit of predictability in your baby’s routine—he wakes up at around the same time in the morning, seems ready for his first nap of the day at about the same time, and may be sleeping for predictable stretches at night— here comes a new developmental milestone: the four-month sleep shift, also known as the four-month sleep regression, or the four-month wakeful period.
Babies who have been sleeping for 5- or 6-hour stretches at night may start waking up much more often, like after just a few hours, or in the middle of the night, or very early in the morning. Babies who have been taking predictable morning naps may suddenly become wide awake and bright-eyed when nap time arrives and stay awake for daytime stretches that last hours longer than they were ever previously capable of before.
Parents may wonder if they should start enforcing some sort of strict napping and bedtime schedule but will find that this is easier said than done, because the issue is biological, not behavioral.
A baby’s new alertness actually coincides with the start of a new stage of neurological development, in which his brain ramps up the production of certain hormones. Four-month-olds also become keenly aware of their environment and are more capable of holding themselves up and looking around.
This new awareness means fewer, shorter feedings during the day (because sounds and activity are so distracting) and a harder time blocking out stimulus at night, paired with a growth spurt and the need to fuel brain development and physical activity by extra nursing binges.
While waking up four times every night may not feel like progress, if you log your infant’s sleep patterns over the course of weeks, you will notice a tendency toward longer sleeping clusters at night.
WHEN WILL BABY NAP?
Early to bed, early to rise!
Most 4-month-olds will tend toward waking up very early (5 a.m. to 7 a.m.), going to bed early (6 p.m. to 8 p.m.), and taking two naps (morning and afternoon). In the morning, expect to see signs of tiredness start to show up about 2 to 3 hours after the last wakeup in the morning, then 4 to 5 hours again after the morning nap.
Hint!
If someone else watches your baby during the day, ask him or her to make a note of when and for how long your baby naps. This can serve as your baby sleep “weather report” for the afternoon and evening. If he hasn’t slept much, you’ll know to keep your baby’s afternoon activities low-key.
SHOULD WE STILL FEED AT NIGHT ?
If your baby is hungry, he’s hungry.
There are sleep books out there—very popular ones, whose “training methods” are followed by millions of parents—that tell you not to pick up your 4-month-old baby or feed him for at least 12 hours in a row overnight, and that he should nap at predetermined times, no matter what. Some rare babies do pull 6-, 8-, or even 12-hour stretches of sleep at this age, but because breastmilk is rapidly digested, for most breastfed babies this expectation is unrealistic. Pay attention to your baby’s cues. If he wakes up and seems ravenous at night, he’s trying to tell you that he needs a nighttime feed for nourishment.
Though it is probably true that if you leave your baby to cry in his crib for 12 hours in a row, he will fall asleep out of exhaustion—and may eventually learn to give up calling for you and lie there quietly, hungry or not—the risk of physical and psychological damage brought on by this “method” seems much greater than any potential benefit.
At this age, your baby is growing at a tremendous rate. Some babies will have doubled their birthweight by now, and will double their weights again by their first birthday. At 3 and 4 months, a baby’s brain is undergoing major development, making new brain cells, and forming new connections between them. This is not a good time to deny a baby the nourishment and nutrients that are so vital for growth.
Like the six-week crying peak, the four-month sleep shift is a normal phase to get through, and it will pass on its own, usually within a month, more or less. In the meantime:
Feed your baby in a quiet room during the day. At this highly distractible stage, you may find that he doesn’t eat as much during the day, because any noise or activity will make him stop feeding and look around. He may even stop feeding just because he wants to look up at you and smile! Bottle-fed babies won’t be as affected by this problem—they can feed from a bottle and check out the scene at the same time—but breastfed babies often start to eat less during the day, and more at night, because daytime has become so interesting, and it’s their way of stoking up for sleeping longer times at night.
Don’t assume your baby isn’t hungry. Even if your baby was previously sleeping 6 straight hours 2 weeks ago but is now waking up every 3, that doesn’t mean he is not hungry now. Don’t worry about getting your baby into a bad habit of feeding at night. This phase will pass, and by 6 months (or sooner) most babies will begin to sleep in longer stretches without feeding on their own. In the meantime, make sure he gets good-size feedings in the daylight hours, so he’ll be less likely to need long feedings at night. A baby’s growth rate during the first year is tremendous, so it’s not surprising that he may seem insatiable sometimes, even if he’s started solids or is formula-fed.
Nevertheless, don’t rush to start solids. When your baby can pick up a spoon or a finger food and place it in his mouth by himself (which typically happens between 6 and 9 months of age), he is developmentally ready to start solids. Studies have shown that adding solids to a baby’s diet does not appear to help him go to sleep any earlier or stay asleep any longer,1 and starting solids before 6 months may increase his risk of anemia, food allergies, and even obesity later in life. Until your baby is an active toddler, any food he eats will mostly just take up space in his gut, make him gassy, and then pass right through him without bestowing much in the way of nutrition. Early solids and formula also stretch a baby’s stomach more than a breastmilk-only diet.
So, don’t start solids too soon, and after you do start them, don’t reduce your baby’s milk or formula intake relative to how much solid food he eats.
Babies have striking differences in sleep patterns. At 4 months of age, formula-fed babies sleep from a half hour to more than 2 hours of total sleep longer than breastfed babies. On average, breastfed babies typically sleep for fewer hours at a stretch overnight—about 3 to 5 hours at the longest point—in contrast to the 6- to 8-hour stretches that formula-fed babies may be able to pull off at this age.
If your breastfed baby usually sleeps in bouts that are shorter than 3 to 5 hours at night but he has slept for longer periods in the past, you can try to hold out between feedings for as long as you know he can go, in the hope of extending his sleep stretches. But most moms find it quite difficult to withhold a feeding from a crying baby for 20 or 40 minutes in the middle of the night—the baby just gets more awake and angry, mom gets more awake too, and the baby will often make up for the time by taking longer to feed and calm down once he finally does get to a nipple. Or, if your baby is extra-smart, he may learn to start crying a half hour sooner, with the expectation that it will take mom that much longer to respond.
Sleeping and Eating by the Numbers
An average of 13.3 hours in a 24-hour period with feedings no longer than every 3–5 hours apart for breastfed infants. An average of 13.8 hours in a 24-hour period with feedings no longer than every 6.5–8 hours apart for formula-fed infants.
AVERAGE DAILY BREASTMILK INTAKE FOR A FOUR-MONTH-OLD:
Eleven 8-minute feedings2
AVERAGE DAILY FORMULA INTAKE:
Between 26½ and 41½ ounces for girls
Between 30 and 43½ ounces for boys
But, at 4 months, formula- and breastmilk-fed infants both need close to the same amount of sleep—about 13½ hours—in a 24-hour period. Remember if you are reading a “sleep training” book that says your baby should be sleeping for longer than 6 hours at a time, that “should” could apply only to exclusively bottle-fed babies.
Think of your baby’s sleep in terms of a 24-hour cycle: The average breastfed baby (and remember, no baby is ever average!) will spend a total of about 3½ hours of out of every 24 feeding.
If you are physically separated from your baby during the day and he’s getting pumped milk or formula during that time, it’s going to be your baby’s natural inclination to want to feed and be close to you at night. Most bed-sharing, breastfeeding babies will want to feed about every 2 hours, and it’s not unusual for larger babies to want to cluster-feed several times an hour overnight in close sleeping quarters.
Breastfeeding and bed sharing tend to go together, especially for babies between 4 and 6 months, who will need to stoke up and cluster-feed for a couple of hours between sunset and sunup, particularly if mom has been away from home for most of the day. A breastfeeding mom who’s not pumping milk or supplementing with formula has two options between 2 and 6 a.m.: try to stay awake while feeding sitting up in a chair, or bring the baby into the grown-up bed. About 75 percent of exclusively breastfeeding moms share an adult bed with their babies for more than an hour a day.3 If you’re going to do this, make sure that you are able to provide a safe sleeping environment for your baby (see Chapter 3). If you feed your baby overnight in a chair, be careful not to fall asleep in your feeding chair with baby on your lap! It isn’t safe, though sometimes it’s hard to help it. Ask your partner to check on you if you don’t return from baby duty in a half hour.
Wake-Up Calls
One survey of both breast- and formula-feeding parents found that from 4 to 12 months, 12.7 percent of babies wake up three or more times every night.4
Also, if nighttime waking(s) are starting to exhaust you, consider working out a compromise with your baby, such as putting him to sleep in his crib earlier in the evening, and then bringing him into your safety-maximized adult bed later. It may not be the ideal arrangement in the long run, but if it helps extend breastfeeding or staves off chronic sleep deprivation for you, then the benefit to overall health will outweigh the difficulty of having to transition your baby back to his crib later.
Feed in dim light with quick, calm nighttime visits. Rely on night-lights, not overhead lighting. If you’re bottle-feeding, keep a bottle with pre-measured formula and some water in your baby’s room, so you can pour, shake, and pop the bottle into your baby’s mouth before he is fully roused. Avoid eye contact with him, which will wake him up even more.
Finally, don’t put a clock in the nursery, and if you have one in the bedroom, turn it toward the wall. It doesn’t help to sit there counting how many hours you haven’t been sleeping.
Q: I have a beautiful 4-month-old little girl. She is breastfed, and since about 8 weeks she has been getting up once a night to feed. About a week ago she started sleeping through the night. Well, for the last couple of nights she’s been up again at 3 a.m. I’m not sure what is going on with me but I’m totally exhausted. I don’t know if it is the fact that this is my first baby and I’m not used to it or what, but I’ve never been so tired in my whole life! Should I try and let her cry it out when she wakes up at 3 a.m. or is she too young? I’ve been so tired lately, I’ve been bringing her into bed with us and I know this is the worst habit to get into. She is with a nanny during the day and takes three bottles, 6 ounces of milk in each (which is a lot for a 4-month-old), and then I typically breastfeed her three to four times daily, sometimes more. I guess if she is going to continue to wake up I need a plan to not be so tired! Any advice would be greatly appreciated!
A: If your baby wakes up crying at 3 a.m. and seems to be hungry—and she seriously feeds, instead of just sucking a bit and dropping off to sleep—then she probably is hungry, and denying her nourishment isn’t going to help her learn to sleep any better. But if she’s up two or three times a night, hunger is unlikely to be the issue.
When a baby’s diet contains both breastmilk and formula, it can be difficult to figure out exactly how much or how often a baby needs to feed, because the calorie content and baby’s intake of breastmilk will vary. With formula feeding, you raise the number of ounces the baby gets as she gains weight. With breastfeeding, the baby gets about the same amount of milk at every feeding, but the calorie density of the milk itself goes up as the baby grows.
Is Something Wrong with My Baby?
Parents often worry that a baby’s sleeplessness will affect his development. A long-term study of 142 babies with sleep problems at 4 to 6 months and 10 to 12 months of age found that sleep difficulties decreased with age for babies who were at low risk for developmental problems, but increased over the first year for babies at high risk. High-risk and low-risk babies both had nearly identical sleep-wake patterns, and their development of body skills was not affected by their sleeping problems.5
Did You Know?
The components of breastmilk will vary over the course of the day. “Night milk” has higher levels of carbohydrates and less protein, and it contains the amino acid tryptophan, a natural tranquilizer.6
Here’s a question: Are you able to successfully put her down in her crib at bedtime “drowsy but awake”? (See Chapter 5, the Nighttime Put-Down.) If so, you know she’s capable of putting herself to sleep without your assistance, so when she wakes up and cries, it’s not because she doesn’t know how to go to sleep without you. Instead, she’s asking you for help with something else. The way to get the most sleep in that situation is to figure out what your baby needs and take care of it as quickly and unobtrusively as possible. Go into her room, don’t turn on the overhead lights, offer her a nipple and let her feed, and when she’s through or her sucking slows down to 5- to 10-second intervals, put her down before she falls asleep completely.
And, yes, if you’re sure you want her sleeping in a crib, for everyone’s sake, it’s best to be consistent. It’s even more confusing to her if sometimes she gets to go into the big bed, and sometimes she doesn’t—that sends her mixed messages and turns nighttime into the lottery!
You may want to consider pumping milk, so that your partner can share in the joys of the 3 a.m. feeding. Or swap out some of the formula feedings during the day with the pumped milk and provide the formula at night.
Is bringing your baby into bed with you the worst thing you can do? Don’t be so hard on yourself! There are costs and benefits to every kind of sleep arrangement.
Bringing your baby into bed at 3 a.m. certainly could encourage more nighttime awakenings and disruptions if she becomes accustomed to waking up and crying and going into the warm, snuggly, big bed. You will have to make your bed baby-safe, and if she’s a thrasher or a wiggler, you may be sleeping more lightly than you would if she were in the crib. (See safety tips for bed sharing in Chapter 3.)
But for your baby, the benefit of sleeping in bed with you is the opportunity to breastfeed more; from a nutritional perspective, the higher the ratio of breastmilk in her diet, the better. She’s getting disease-fighting antibodies, custom-made brain-building fatty acids, and a plethora of health benefits.
And the benefit to you, of course, is more sleep. Sometimes moms sleep more lightly if they expect to hear their baby. So once the baby’s in bed with them, they can relax more, knowing they won’t have to get out of bed again.
If you bring your baby into bed with you on a regular basis, consider that she’ll have to re-learn how to sleep in her own bed at some point. This may not be as hard as you fear and may only take a night or two, or it may be difficult. It depends on how old your baby is when you put her back into her own bed, how consistent you are in getting her to sleep there in the future, and her individual temperament.
Remember that for the first year of a baby’s life, the whole family will be in the process of constantly tweaking schedules and re-learning how to do everything together—eating, drinking, sleeping, staying clean—usually one-handed and backward while holding the baby. And once you get the hang of it and get into the groove a little bit, the nanny will quit, or you’ll get fired, or the baby will get sick, or the car will break down, and you’ll have to re-learn everything all over again.
The point is, while it’s good to have set routines and schedules that you can stick to, it won’t always be possible, and sometimes you’ll find that other things—sleep, health, sanity—have to take precedence. It’s okay to decide that what you’ve been doing isn’t working out.
Being sleep-deprived is not a state that anyone can reasonably be expected to maintain for very long. Going to bed earlier and taking naps can certainly help pay off your sleep debt, but not everyone’s schedule will allow for that.
Q: My 5-month-old has been sleeping in bed with us since birth. We’ve tried putting him in his bassinet and his crib to sleep at various times, but if we put him down when he’s awake, he starts crying immediately, if we put him down when he’s asleep, he wakes up and starts crying as soon as he realizes where he is. So in the interests of getting sleep, he always ends up back in the bed, and that’s been okay . . . until recently. Lately he’s been waking up every 2 hours or so, kicking and squirming until he finds a nipple, then nursing for just a few minutes before he goes back to sleep. If I turn over to face the other way, he kicks my back. I feel like a human pacifier. I’d like him to sleep in his crib and nurse just once or twice a night, but I don’t know how to get there.
Are You More Tired Than You Should Be?
Consider that there may be other factors contributing to your fatigue— most commonly anemia, post-partum thyroiditis, post-partum depression, and/or certain medications you may be taking. If you’re going to bed at a reasonable hour (9 or 10 p.m., say), being awakened once at night may be unpleasant but shouldn’t be completely debilitating under normal circumstances.
Your doctor should test the levels of iron and thyroid hormones in your blood and ask questions about your moods to determine if you’re at risk for depression. Also be prepared to tell your doctor about any medications you’re taking (which drugs, the dosage, and how often you take them), including any over-the-counter medications. Allergy medicines, particularly Diphenhydramine hydrochloride (Benadryl®) and cetirizine hydrochloride (Zyrtec®), are common culprits when it comes to prolonged fatigue.
A: Your sleeping arrangements aren’t working, and it’s time to re-evaluate.
It sounds like your baby hasn’t learned how to go to sleep by himself. He’s nursing at night not because he’s really hungry, but because he’s waking up as he moves out of one sleep cycle to the next, and he doesn’t know how else to put himself back to sleep. If it’s starting to affect your ability to function, it’s time for him to learn how to sleep on his own!
First, when and where does your baby nap during the day? Do you put him down in his crib at specific times, or are you winging it with a buffet of car seats, strollers, swings, and slings?
If you’ve been letting him fall asleep during the day whenever and wherever, then it’s time to pin down regular times and places for his daytime naps. Somewhere between 90 minutes to 3 hours after he wakes up in the morning, he’ll be ready for a nap. (Read more about putting baby down for naps in Chapter 2.) About 2 to 3 hours after he wakes up from that nap, watch for signs that he’s ready for another.
There may be some complaining cries as you put him down in his crib to fall asleep by himself for those first naps while he’s still awake. But he’s now old enough that you will probably be able to tell the difference between the cry that means he’s hungry, the one that means he’s sleepy (but can’t figure out how to settle himself down all the way), and a cry that means “I’m wide awake! Get me out of here!”
If you’re not comfortable with hearing any crying, or your baby just gets wide awake and furious, then pick him up and soothe him until he seems drowsy again. Then put him back down before he’s completely asleep. If you wait until he’s completely asleep, he may wake up alarmed after only a very short time because he doesn’t know where he is.
You can stay in the room with him if you sense your presence is soothing. But if it makes him more wide awake and enraged, you may want to step out to give him a chance to settle.
If you are consistent about insisting that your baby does his sleeping in the crib—falling asleep there, and not on top of you or with the use of vibration or motion or pacifiers—he will eventually adjust, and being put down in his crib will become a cue for him that it’s time to go to sleep.
Once your baby is able to put himself to sleep in his crib at regular intervals for naps during the day, nighttime will be a much easier transition. Set a date for when you plan to start having your baby sleep in his crib overnight, and make sure no one has to get up early the next morning! Your baby may wake up multiple times at first, as he gets used to putting himself back to sleep at night—without being able to roll over and “snack” any more—and as long as he is breastfed, he will still probably wake up a few times to be fed at night. But that’s better than eight or ten times a night, right?