Baby (0 to 4 Months)

HEALTHY SLEEP HABITS

Your Baby’s Sleep: The Goal of the First 4 Months

Your Baby’s Sleep Timeline: What to Expect

The Magical 7:00 p.m. Bedtime

Bedtime Routines

Your Baby’s Environment and Soothing Tips

Safe Sleeping Practices

SLEEP SOLUTIONS

Encouraging Self-Soothing

The Soothing Ladder Method

Naps and the 90-Minute Awake Window

Fussiness, the Witching Hour, and Colic

Sleep Regression

Breast- or Bottle-Feeding and Sleep

Parent Sleep: Help in the First 4 Months

TROUBLESHOOTING SLEEP

0 to 4 Months

Baby getting own room, to schedule or not, rolling to tummy, teething, swings and other devices, illness, catnaps, napping on the go, waking up shortly after bedtime, reflux.

HEALTHY SLEEP HABITS

YOUR BABY’S SLEEP: THE GOAL OF THE FIRST 4 MONTHS

Sleep is something that new moms and dads think about, ask about, crave, and compare notes on constantly. Newborn schedules are so erratic and the quest for a full night’s rest so pressing, it makes sense that sleep is the most popular topic of conversation (it probably doesn’t help that How’s she sleeping? is every friend, family member, and stranger’s favorite question).

In the first 4 months of your baby’s life, she may not sleep through the night (Chapter 4 outlines the path to sleeping through the night for babies 5 months and older), but we’ll show you how to set the stage and encourage your baby’s sleep to gradually grow longer and longer.

THE GOALS OF THIS CHAPTER ARE TO:

Establish good sleep patterns and the right sleeping environment in your home.
Give you tools to support your newborn’s growing self-soothing skills, and explain how to strike a balance between soothing and encouraging self-soothing.
Avoid common pitfalls (like repeating habits automatically) that interrupt your baby’s natural sleep progression.

A key idea in this chapter is the “curious stance.” Very young babies need a lot of help from parents to calm their developing little nervous systems—that’s why we naturally rock and sway as we hold them in our arms. But over time, they gradually become able to take over this role of soothing (self-soothing) to fall asleep. The problem is that when a parent gets in the habit of automatically repeating soothing actions over and over (like bouncing and rocking to sleep), as time goes on, it begins to mask the baby’s budding abilities. On the other hand, a curious parent watches closely and notices moments when the baby is okay on her own and doesn’t need help. The curious stance is the path to knowing when to soothe your baby, while gradually, over time, stepping back to give her space so she can show you what she’s capable of.

Whether you have a newborn who sleeps 5 hours at a stretch, or one who wakes up every 2 hours around the clock, we guarantee that soon your baby can sleep well. We’re going to help you build a good foundation for healthy sleep no matter what your baby’s starting point.

Your Baby’s Sleep Timeline: What to Expect

Newborn: Sleep off and on; irregular pattern

8 weeks: One 4- to 8-hour stretch of sleep at night; frequent and unpredictable daytime naps

3 months: Most baby sleep has shifted to night; more awake during the day

5 to 6 months: Circadian system matures. Most babies able to sleep 11 to 12 hours at night.

Newborns typically sleep 16 to 18 hours a day, made up of frequent naps and stretches of nighttime sleep. A newborn’s sleep is naturally erratic, because her nervous system and internal clock are immature (see Chapter 8). In other words, new babies are supposed to sleep in fits and spurts. This can truly be a shock to the system for parents, who are used to being in control of when and how long they sleep. We know from firsthand experience how grueling this is, and how painful it can be (some would say it feels like torture!) to rise from a deep sleep to feed and soothe a newborn. When you’re in the midst of it, it feels like it will never end—like your deep craving for sleep will never be satisfied.

It will. As the newborn months pass, your baby’s sleep skills grow and the family will eventually sleep well again and have a consistent routine. Every baby’s sleep development is different, though—some tuck into long stretches of sleep within a few weeks of birth, while others continue to wake up every few hours for months. If your baby is premature, sleep can take more time to unfold, but your baby’s sleep will catch up, as the effects of her adjusted age fade. It’s important to know that you can’t expect a very young baby to adhere to a schedule (nor do you want her to, because feeding on demand is the way to establish successful breast-feeding). It’s best to follow her lead and allow her body time to mature into a regular sleeping pattern.

Day-Night Confusion

When you bring your tiny bundle home from the hospital, she may sleep for periods off and on around the clock, without any distinguished pattern of day and night. This is typically referred to as “day-night confusion”—the result of your baby’s undeveloped circadian system. When she was nestled tightly in the womb, your baby got signals about the time of day from you, because chemicals like melatonin were rising and falling with your circadian rhythms. But after birth, and without these chemical signals coming from Mom, a newborn’s biological clock on its own is very immature—that fact makes for unpredictable sleep and restless nights.

It takes months for your baby’s internal clock to mature. This is a normal developmental process—it will happen, it just takes time. You can encourage your baby’s grasp of day and night by:

Exposing your baby to indirect sunlight during the day. To best signal his internal clock, venture out early in the day. Try for a 10:00 a.m. walk, or sit on the porch at this time. Just remember not to keep your newborn in direct sunlight.
Letting him know it’s morning. When your baby wakes up for the day, sing him a song and open the shades to let in sunlight.
Gently waking your baby during the day to feed at least every 3 hours.
Keeping him in the living areas and activity during the day, and in a dark, quiet room at night.
Lowering the lights in the house at night (even if your baby is awake).

A particularly challenging time for many parents can be 4 to 6 weeks, as babies begin to “wake up” from their sleepy newborn state. This new alertness (which you can also see in baby’s ability to smile, for example), combined with an as-yet still immature nervous system, can make sleep elusive. Your baby might seem extra fussy around this period. Some parents feel like during the first four weeks of their baby’s life, they run on adrenaline, and after it wears off and their baby’s sleep is still erratic, they feel truly sleep deprived.

Around 8 weeks, many babies begin to sleep for one long stretch at night (this could be 4 to 8 hours). This usually happens in the beginning of the night, while babies often continue to wake up every 2 to 4 hours for the rest of the night and take frequent daytime naps.

Most 3- or 4-month-olds are capable of sleeping at least 8 hours continuously, but some still wake up every 2 to 4 hours, and some who were sleeping long stretches actually start to wake up more frequently (see “Sleep Regression”). At this point, fussiness can be a sign that your baby is tired (see “Naps and the 90-Minute Awake Window”).

By roughly 5 months, your baby is capable of sleeping 11 to 12 hours at night (as you’ll learn in the next chapter, this may include feedings). Most doctors agree that by 6 months of age, babies are capable of sleeping 11 to 12 hours without eating. Some parents choose to wean all feedings at this point, while others keep feedings in place. If your baby is still eating at night beyond 5 or 6 months, these feedings can be brief, and (with our help), he can return directly to sleep so that his sleep and yours will be almost continuous.

The Magical 7:00 p.m. Bedtime

It’s common in the first weeks of life for newborns to be out in the living room with their parents until late in the evening. But somewhere around 6 to 8 weeks, you may notice that your baby tucks into a longer stretch of sleep starting at around 6:00 or 7:00 p.m. This is because her circadian system is maturing and beginning to send her little body signals to fall asleep roughly with sunset. If you see this stretch of sleep in the early evening, it means that your baby is ready to call it a day roughly around sunset. In Chapter 8, you can read about circadian rhythms and how your baby’s internal clock matures.

In fact, the “witching hour” (a period of fussiness and crying) that so many parents see in the late afternoon/early evening is often a sign of overtiredness. During the day, and especially in the evening, you’ll start to notice that your baby’s discontent is a signal that she’d rather be sleeping (even though it can still be difficult to get her to sleep, because her body is dysregulated).

Seven p.m. is a magic time. If you try to keep baby up, it can backfire because she becomes overtired and less likely to sleep well. On the other hand, an earlier bedtime often begets a longer and longer stretch of sleep over time. As your baby’s internal clock matures, she is likely to start waking up very early. Given this natural tendency for early rising, putting her down at 7:00 p.m. gives her the best chance of getting the 11 to 12 hours of sleep she needs. Your baby may not seem tired, but that’s okay. The optimal time to put your baby down is not when she’s yawning and fussing, but before this, when she’s quietly cooing or playing.

MADELINE’S EARLIER BEDTIME MAKES FOR LONGER SLEEP

Liz: Madeline started trying to nap from 6:00 to 7:00 p.m. each night, so when she was 3 months, I was able to convince my husband to put her to bed earlier. We also made her room more cave-like. The first night she slept 11 hours! I heard her a few times on the monitor and watched her move around to get comfortable and once saw her bring her hands to her mouth to self-soothe, but each time she quickly went back to sleep on her own. It worked so well for us, I wish I had tried it even earlier. Before the change, she was going to bed pretty late (10:00 p.m. or later some nights) and only sleeping 7 to 8 hours.

Start moving toward this bedtime at least by the time your baby is around 10 weeks old. If your baby is going to bed later than 7:00 p.m., you can move bedtime back 15 minutes or less every night, or simply put her to sleep at this time right away—after several nights, she will likely adjust. While you’re thinking about bedtime schedules, keep in mind that after the first 8 weeks or so your baby will be ready to sleep approximately 90 minutes to 2 hours after waking up from her last nap, so take her final naptime into consideration. You can gently wake your baby in anticipation of her needing a 90-minute awake period before bedtime. Up to about 3 months or so, many babies can occasionally nap until 6:00 p.m., be gently roused for their bedtime routine, and go right back down at 7:00 p.m. This is good to remember because at this age, naps are very erratic.

Does this mean you’re homebound after 6:00 p.m. from now on? No! Lots of parents can easily tote a sleeping newborn baby into a bustling restaurant. Just be aware that your child’s internal clock is developing, and an early bedtime is a good idea. By 4 months, she’ll probably do best with her own sleeping place at home for a consistent bedtime.

3-MONTH-OLD LEO MOVES FROM 9:00 TO 7:00 P.M. BEDTIME

Stephanie: When I first learned about the 7:00 p.m. bedtime, Leo was about 3 months old and going to bed at about 9:00 or 9:30 p.m. We tried moving bedtime to 7:00 p.m. right away, but he wasn’t ready yet. A week later, though, I started to see him naturally wanting to go to bed earlier and earlier. Now, he goes to bed at 7:00 p.m. and sometimes a bit earlier if it’s been a busy day. He is a happy 7:00 p.m. to 7:00 a.m. sleeper with usually one feeding per night.

BABY BEDTIME: THE CASE FOR WATCHING THE CLOCK

Establishing a set bedtime enlists the forces of your baby’s powerful internal clock. Even a small, nightly fluctuation in bedtime can lessen this effect. When you keep to a regular schedule, your baby’s ability to self-soothe, fall asleep, and stay asleep is greatly enhanced. Bedtime is an aspect of sleep with which we urge you to be very consistent. It might feel like a mechanical adherence to the clock, but remember that your baby has an internal clock that wants things to come at predictable times.

Bedtime Routines

Remember from Chapter 2 that babies are natural pattern seekers, and they learn routines very quickly. One of the best ways to harness this pattern-seeking power is with the right bedtime routine. The consistent, soothing motions that you go through right before bed will become a potent cue for your baby to wind down and shift into sleep mode. Put your bedtime routine in place before you think your baby needs it (6 to 8 weeks is a good time to start) because the predictability helps set the stage for her growing ability to self-soothe.

Sample Bedtime Routines

These are just examples. You will find your own special steps (for example, some parents include baby massage—others have their own rituals); just be sure you choose soothing rather than activating ones, and keep the same order, with a calm tone.

0 to 2 months	3 to 5 months	5 to 7 months
Bath	Bath	Bath
Massage	Pjs	Massage
Pjs	Feed	Pjs
Feed	Baby-led play	Feed
Songs while you sway	Book(s)	Book(s)
Bed	Songs while you sway	Say good night to objects in the room
	Bed	Song while you sway
		Bed

The Soothing, Repetitive Routine

Your bedtime routine should be 30 to 45 minutes long at this age and consist of things like a bath, infant massage (see “Baby Massage Basics”), pajamas, books, feeding, songs, and bed. If your tone is warm and calm, the steps of the routine are predictable, and the end of the routine is clear, your baby will learn this and her body will expect the transition to sleep. We like to say that you can stand on your head as the last step of your bedtime routine—it really doesn’t matter, as long as you do it the same way every night! Always end with the same song and keep your last words to your baby, like “Night, night, I love you,” consistent as well.

Separate Feeding from Sleep

Try not to feed your baby as the very last part of your routine, because it can quickly create a strong association between drinking milk and falling asleep. This sleep association is one of the most likely to interrupt the process of your baby turning inward to soothe herself to sleep. If you look for opportunities to loosen this association now, it will create more space for your baby’s growing ability to self-soothe down the road. Singing a song (the same one every night) between feeding and putting your baby in bed is a great way to end the routine instead.

Try putting your baby down and then shushing and patting her a little as she falls asleep instead of lowering her into her sleeping place already asleep. This way, when she wakes during the night, she won’t be surprised to find herself in bed. As you know, all babies are different; at this age, some will still need to be fed to sleep. Just remember to stay curious and be willing to try putting your baby down a little awake. If your little one still relies on being fed to sleep when she’s 5 months old, we’ll show you how to change this pattern in Chapter 4.

Slow Down, Your Baby Is a Sponge

Your baby has an astounding ability to pick up on your mood and energy level. The more centered and relaxed you are, the easier it will be for your baby to feel exactly the same way. It doesn’t mean that you have to keep everything completely quiet (we don’t want you tiptoeing around for the next five years); just imagine sending a signal of calm, rather than the disquieting cue, “Please, just fall asleep!” Take some deep breaths yourself—a good way to slow your nervous system down. What you do in your routine doesn’t matter as much as how you do it.

When we lead parenting groups, we often have parents share their routines with each other. One day, a mom described how she spread a swaddle blanket on the bed as she began her routine. As she demonstrated it for the group, her voice got soft as her arms smoothly spread the blanket out. There was a collective deep breath and sigh in the room—some moms started to yawn!

Don’t underestimate the power of your baby’s “sponge neurons” or “mirror neurons” (brain cells that are affected by the mood and behaviors of those around us). Babies are exquisitely attuned to our intentions and internal states (meaning whether we are activated or relaxed), so slowing down can help enormously. In fact, studies show that when caregivers holding their babies have heart and respiratory rate changes, babies’ rates change right along with them.

Baby-Led Play

By 3 months of age, babies really like 10 to 15 minutes of quiet, baby-led play as part of their routine. During this time, get down on the floor with your baby and just watch and follow her play. It’s a chance to shift from you doing things to your baby (the way the daytime often goes while you’re feeding, bathing, carrying her, and so forth), to your baby being in charge and showing you what she is interested in. As your baby feels your attention, her brain becomes primed for self-regulation, which will help her sleep. In the first 4 months, baby-led play is very simple; it might just mean mirroring her expressions and following her gaze. Try, and see if your baby likes it.

Do the Last Steps in the Room Where Your Baby Sleeps

Move into the room where your baby is sleeping for the last steps of the routine, dim the lights, slow down your voice and movements, and keep things quiet. Light—both natural and artificial—affects sleep for people of all ages, so dimming lights for an hour before bed (including avoiding TV, computers, and all screens) is helpful to all of us.

Your Individual Baby

The ingredients of your bedtime routine will depend on your baby. Some babies will clearly indicate at a certain point that they no longer want to lie still for massage or want to get into their bed sooner and get comfortable while you sing the last song or say good night. Some parents sing the last verse as they’re walking out of the room.

Julie: When Jack was a baby, he loved to be sung to right before sleep. By that time, I was so tired that I would lie on the floor and put my feet up on the edge of his mattress and I would “sing to my toes.” I don’t really know how we ended up with that zany ritual, but it’s a good example of coming up with your own! He knew which was our last song, after which I got up, said “Night night, sleep tight, see you in the morning light,” and quietly left the room.

BABY MASSAGE BASICS

A little soothing massage gives your baby’s body and nervous system a fabulous path to falling asleep. Massage reduces stress levels, supports well-being and bonding, boosts immune function, and promotes brain development.

Lay your baby down on a warm, flat, safe surface where you are also comfortable.
Put a little pure vegetable oil, such as sweet almond oil, into your palms and rub your hands together to warm the oil.
Make eye contact with your baby and let him know you are starting the massage.
Wrap your hands around one of his thighs and pull down, one hand following the other. Use a gentle “milking” motion to massage down the length of both legs.
When you get to the little feet, use your thumbs and trace circles all over the soles and then gently pull on each toe as you slide your fingers off the end.
Place your hands flat over baby’s chest and stroke outward in big, slow circles.
With one hand flat across baby’s chest, stroke downward to his thighs on both sides.
Take up each little arm and repeat the milking motion from shoulder to hand, rotating the wrists a few times in each direction.
Trace circles on baby’s palm with your thumbs and gently pull on each finger, sliding off the end.
Gently roll baby to tummy and trace circles on either side of his spine, moving up and down from neck to waist.
Finish with long, firm strokes all the way from shoulders to feet.
Babies generally like a gentle but firm touch, rather than a super-light, ticklish touch.

Follow your baby’s cues and stop if he’s had enough. It’s normal for babies to begin to resist massage as they become more mobile and active; you can build it into another part of your day if and when it no longer helps him wind down at bedtime.

Your Baby’s Environment and Soothing Tips

Your baby’s environment can support or interfere with sleep. Along with his physical environment, your baby’s feeling of being connected with you is key. It’s good to know that you cannot spoil your baby—not only does his nervous system need your responsiveness and soothing, he is naturally geared to monitor whether he’s cared for and safe. Hold, comfort, and make a lot of physical contact with your baby—this helps him internalize a sense that he’s loved and that the world is a good place.

QUICK LIST: ENVIRONMENT AND SOOTHING

White Noise

Your baby is used to the muffled sounds he heard in the womb, and may be soothed and calmed by white noise that emulates it. Instead of using constant, loud, and monotone static white noise, use nature sounds like waves or rain, which have slight variations. You can also use a fan (a little moving air is also consistent with safe sleeping recommendations) on a low or moderate volume. Keep the noise going all night rather than using a timer or a device that shuts off. Once your baby is about 4 months old, white noise is no longer needed for soothing, but you can certainly keep it as a way to mask noises from inside and outside the house.

Light

Light is an important cue to help your baby sleep and wake, so use light to your advantage. Put up shades or curtains in your bedroom (or wherever your baby is sleeping) to mask early morning light. Even the first hints of sunrise can send alerting signals to your baby, so a very dark room gives him the best chance of sleeping longer. You can achieve this by installing blackout shades, putting up temporary darkening shades, using blackout fabric, or even just taping dark garbage bags over the windows.

When your baby wakes up for the day, make sure that his brain and body know it’s daytime. Gently pull back the shades, sit on the porch in indirect sunlight, or go for a walk in the morning to help his developing internal clock. Talk to him and sing a good morning song!

Walking, Rocking, and Carrying

Your baby feels soothed by your warmth, the feel of your skin, and the motion as you carry him. Tote him around, wear him in a sling, and allow him a lot of time in contact with you. Walking outside is often very calming to babies because of the motion, change of environment, light, and fresh air.

Swaddling

Newborns have a startle reflex that regularly sends their legs and arms flying. For safety reasons, we put our little ones on their backs for naps and bedtime, but this means that the jerking motion can really disrupt their sleep. Snug swaddles keep limbs hugged toward the body and many babies sleep better this way. Most babies do well being swaddled until they are 2 to 4 months old. There are also some babies who never like being swaddled and do just fine without it.

SWADDLING HOW-TOS

Remember to always put babies down on their backs to sleep.
Keep the room cool—65 to 68 degrees Fahrenheit.
Use breathable fabrics and don’t overdress baby for sleep.
Keep the sleeping surface free of any loose blankets, pillows, or positioners.
Stop swaddling when your baby can roll over at all, in either direction, since it can pose a suffocation risk.
Stop swaddling when your baby can kick out of the swaddle, but make sure he didn’t just kick out of the swaddle because it was put on too loosely. You can now use a blanket sleeper, sleep sack, or simple cotton pj’s.
In order to keep baby’s hips healthy, leave plenty of room for baby’s knees to spread apart, bend up, and move around in the swaddle. Just as in the womb, this position allows the hip joints to develop naturally, preventing loosening or damage to the soft cartilage of the socket. It’s fine for the upper part of the swaddle around the arms to be a little snugger.
Swaddle with your baby’s elbows bent and arms folded on the chest. This mimics their position in the womb, ensures healthy joint development, and is calming and regulating. Babies have a natural instinct to work their fingers and thumbs toward their face for self-soothing; this swaddling position gives them every opportunity to do that.

When your baby is ready for un-swaddling, you can go cold turkey, or start by leaving one or both arms out for a few nights. The transition will be a little bumpy, whether you do it right away or wait a few weeks. It’s better to err on the side of safety and un-swaddle as soon as baby can roll.

Some parents find it hard to let go of swaddling because they’ve always linked it to better sleep, but coming out of the swaddle is a logical step in sleep development. The end goal is for your baby to find his own comfortable sleeping positions, so having freedom of movement is key. It may disorient him at first, but trust us, this is a step in the right direction. Everything you can do to encourage movement and agility will have a positive effect on sleep, because when your baby chooses his own body positions, he’ll sleep better. It may be on his tummy, with an arm outstretched, knees tucked under, bum up in the air . . . you won’t know until he has the chance to practice.

This is why we like to see babies graduate into long-sleeved, long-legged cotton onesies with feet (with a similar “blanket sleeper” as a second layer during cold seasons) instead of sleep sacks, which can get twisted or hamper movement. Do everything you can to ensure that, once your baby can roll, he’s free and can move at will around the crib. Now he can shift around and resettle during the night, just like the rest of us.

Many babies have a brief period of wild rolling and traveling around the crib when this ability first emerges. As with all sleep regressions and developmental surges, it’s temporary and will subside as the novelty wears off.

3½-MONTH-OLD’S SLEEP IMPROVES POST-SWADDLE

Carla: Cece struggled to get her arm free of her swaddle at 3½ months. We considered wrapping her even snugger, but she seemed to want the opposite. We tried un-swaddling and, almost immediately, she started to suck her thumb to soothe herself to sleep. Her sleep improved dramatically, even though she wasn’t rolling yet—she’d figured out her own soothing technique.

The Need for Sucking

Many babies have a strong need for sucking (which is separate from their need for nourishment), so you can encourage either thumb or pacifier use to satisfy this need and improve the capacity to self-soothe. The current American Academy of Pediatrics recommendation is to use a pacifier for bedtime and naps, but you don’t need to reinsert it if it falls out during the night (see “Safe Sleeping Practices”). Which is better, pacifier or thumb? Truly, they each have their pros and cons:

Pacifiers

Pacifiers take a lot longer for your baby to be able to insert solo, but they are much easier to take away when the time is right. Some moms worry that this will interfere with breast-feeding but research does not support this idea—babies know the difference!

Thumbs

Thumbs are readily available, easier to insert (once they learn how), and don’t get lost in the crib. The downside can be that it’s trickier to stop thumb sucking down the road (although most children will naturally stop thumb sucking if it isn’t given any attention or judgment).

Your Nighttime Station

It will help both you and your baby if you can prepare the items you’ll need overnight and put them in a convenient place before bed so you don’t need to do any extra work when your baby wakes up. Put diapers, wipes, an extra set of pajamas, a glass of water, your feeding pillow, and anything else you might need for nighttime awakenings right next to your bed. Have a dim nightlight next to you and keep your feedings as unstimulating as possible (try to resist chatting with your adorable bundle at this hour of the night). If your baby is within arm’s reach, you may not even have to get out of bed to take care of him and put him back down again.

Safe Sleeping Practices

Here is a summary of the American Academy of Pediatrics (AAP) guidelines for safe sleeping. These are best practices for lowering the risk of sudden infant death syndrome (SIDS), as well as suffocation and other sleep-related deaths.

Always put your baby on her back to sleep for naps and nighttime.
Room sharing, without bed sharing, is recommended for these early months. Sleeping in the same room with parents has been shown to lower the risk of SIDS.
Always use a firm sleeping surface: your baby’s mattress should be firm—avoid a sagging or soft mattress or one that has been handed down, heavily used, or old. Car seats and other sitting devices are not recommended for routine sleep.
Keep soft objects and loose bedding out of the bed. This includes bumper pads and any kind of wedges or positioners, which can up the risk of suffocation since babies can scoot and position their faces against them. Your baby’s sleep surface should be a simple fitted sheet without stuffed animals, pillows, or blankets.
Once baby can roll even a little bit in either direction, it’s time to stop swaddling.
Don’t put a hat on baby during sleep due to risk of overheating.
Breast-feeding, for moms who are able, is associated with a reduced risk of SIDS. Exclusive breast-feeding for at least the first 6 months is recommended.
Offer a pacifier at naptime and bedtime. Having a pacifier while falling asleep has been shown to reduce SIDS risk. You don’t need to go in and reinsert your baby’s pacifier after it falls out, however.
Avoid overheating: keep the room temperature cool (around 65 to 68 degrees Fahrenheit is ideal) and do not overbundle your baby.
Have a little moving air in baby’s room right around the level of their face. An air purifier or low fan works well for this.
Avoid smoke exposure, alcohol, and drugs during pregnancy and after birth.
Do not use home cardiorespiratory monitors (home monitors) as a strategy to reduce SIDS risk.
Infants should be immunized in accordance with AAP/CDC (Centers for Disease Control and Prevention) recommendations.
Supervised, awake tummy time is recommended to facilitate development and minimize the occurrence of flat head.

SLEEP SOLUTIONS

Encouraging Self-Soothing

Self-soothing is the number one skill your baby needs for good sleep, both now and in the future. Many sleep problems for children of all ages have to do with trouble self-soothing, so it’s great to understand and support this ability early on.

As you know, newborns need a lot of soothing from us—remember they have been nestled, carried, and bounced naturally for 9 months. In fact, the “vestibular” sense, or the sense of motion, is one of the very first senses a fetus develops (at just 10 weeks after conception—when baby is still smaller than a fig—she begins to perceive movement), so she has spent almost all of her precious little life feeling the rise and fall of your footsteps and other behaviors throughout the day. Human babies are born in a very immature state, with nervous systems that require a lot of input from caregivers. This is why we wrap small babies in our arms or hold them over our shoulder while we walk around the house, rock them in gliders, and tuck them into slings. The first few months are also the time when soothing and responding to baby’s cues are essential. As you do this, your baby builds trust in you; as she builds trust, she will naturally feel more relaxed. This is secure attachment. Babies who feel this security will explore more, develop naturally, and become more independent over time.

Babies who are responded to with sensitivity during the early months are gradually able to turn to their self-soothing abilities. Being able to self-soothe to sleep means feeling confident in your own sleeping place and able to get comfortable and drift off. In the first months of life, your baby will go from needing a lot of external soothing (shushing, rocking, and so forth), to gradually being able to take over this job herself. When she starts to self-soothe, she might do this by tucking her arms under her chin, moving her head from side to side, or making little noises to get comfortable—whatever she figures out as her own personal technique. It’s really sweet to see babies find their special ways of self-soothing.

As the parent of a newborn, you get to watch this process unfold. As you nestle with her, pat, feed, and bounce her, you can also look for chances to let her flex her budding sleep skills. The following tips will help you with this goal.

QUICK LIST: ENCOURAGE SELF-SOOTHING

1. Put your baby down awake. Look for opportunities to put your baby down awake at least once a day. A major reason babies wake up and cry is because they find themselves in a sleeping place they didn’t go into knowingly.

2. Loosen the feeding-sleep association. Gently remove breast or bottle at the end of a feeding before baby falls asleep.

3. Discern your baby’s sounds. If baby is fussing, whining, grunting, squawking, babbling, or making any other such noise, resist the urge to swoop in! Babies can be very noisy on their way to self-soothing.

4. Use the Soothing Ladder to avoid overhelping. If your baby wakes up at night and cries for about a minute, be curious about the least intrusive thing you can do to settle her.

5. Don’t let your baby cry for more than a minute. As you’re encouraging self-soothing, don’t let your baby cry for more than a minute during the first 4 months.

6. Daytime independence. Look for moments during the day when your baby is happy to hang out solo. What better way to nurture confidence and self-regulation.

7. Transitional object. Also known as a lovey or blankie, this is a soft, special object your baby can use to help her self-soothe.

8. Tummy time. Tummy time is important for your baby’s sleep. Once she can roll and move (usually around 4 months), your baby has skills for getting comfy and sleeping well.

Did you know that babies, children, and adults all wake periodically during the night as we go through our sleep cycles? When you compare babies who are “good” sleepers with those who are “bad” sleepers, which ones do you think wake more often? The answer is, both groups wake with the same frequency—it’s just that the “good” sleepers are practiced at self-soothing, so we don’t realize how often they wake up. Babies’ sleep cycles are about 60 minutes (compared to an adult’s 90-minute cycle), so those who can’t soothe back to sleep have many times during the night when they may potentially call out for help.

SCAFFOLDING AND SLEEP

As you read the following list of strategies, keep this idea of “scaffolding” in mind.

Scaffolding is a concept used in child psychology that helps parents know how much to help, versus how much to back off and allow their baby or child to struggle a little while practicing a new skill.

Imagine you, the parent, are the scaffolding and your child is the building. You know that scaffolding around a growing building gives just enough support to allow the building to grow, and is gradually taken down as the building gets stronger. In the same way, you are ready to give your baby just enough support to grow and progress, while allowing her to struggle a little as she gets stronger and shows her new, budding skills.

1. Put Your Baby Down Awake

There’s nothing more natural than your baby dozing off in your arms. As moms ourselves, we both remember it as one of the sweetest experiences of new parenthood. And let’s face it, especially if you’re breast-feeding, your newborn baby falling asleep in your lap is practically an unstoppable force. Soak up this beautiful time.

The hitch is that, as your baby reaches 3 months of age, the learned association between feeding, rocking, bouncing, or swinging and falling asleep becomes stronger, and your baby becomes very aware of, and reliant on, that pattern. Gradually fading these sleep associations in the early months, when a baby’s awareness is lower, can be very effective and easier than doing it later. For this reason, we recommend that you look for opportunities to put your baby down drowsy but awake. Do this as often as it works for you, so that your baby has the space to fall asleep by himself if he can.

Going to bed slightly awake also helps your baby sleep much better through the night, because he won’t need as much help from you to settle back to sleep every time he briefly wakes (which all babies, children, and adults do throughout the night as they cycle through stages of sleep). Imagine, from your baby’s perspective, what it’s like to be put down in his crib or bassinet already asleep:

He drifts off warm and nestled in your arms, feeding or rocking. A few hours later (or even a few minutes later), he wakes up alone, on a flat surface in the dark. Understandably, he cries out because he’s thinking, “Wait a minute, something is wrong. Where am I? Come back and make all that happen again so I can go back to sleep!”

A baby who is put down in his sleeping place—whether it’s a bassinet, crib, or otherwise—drowsy but awake at bedtime is more likely to resettle and sleep longer at night. On the other hand, a baby who is placed in bed already asleep will often call out to parents at night because he finds himself in conditions he didn’t go into knowingly.

After your baby is about 2 months old, he’ll be drowsy after not more than 90 minutes of awake time so watch the clock, swaddle, and place your little one down when his eyes are still open (often the first nap of the day is the easiest). If your baby cries for more than about 1 minute, you can use the Soothing Ladder to calm him and then try to put him down drowsy again. You can do this over and over until he falls asleep. The more you do it, the sooner you begin to see progression. Over the course of a week or so, you may see the number of times your baby needs you to soothe him decrease, until he is used to being put down awake and doesn’t need your help at all. This technique is much more effective with young babies, under about 4 to 5 months. It takes a lot of patience initially, but it can really pay off.

PICK UP, PUT DOWN

JoAnne: The first time I put my newborn, Dane, down a little bit awake, he fussed and I had to pick him up and calm him 25 times, until he finally fell asleep! The following nights, the number of times decreased slightly, until after about a week, I could put him down awake and he would soothe himself to sleep.

If your baby doesn’t fall asleep on his own yet, it’s not a reflection on his future as a bad sleeper—he will get there, we promise. A baby who doesn’t fall asleep on his own in the first 4 months will still be a great sleeper later on, if you employ the techniques in Chapter 4. What your baby wasn’t able to do today, he may surprise you by doing tomorrow—that’s why we ask you to take a curious stance.

2. Loosen the Feeding-Sleep Association

This tip is related to putting your baby down awake. During a feeding, before your baby falls asleep, you’ll see her go from drinking milk to merely suckling or pacifying on the breast or bottle. If you pay attention to when swallowing (slower, steady, with clear swallows) turns to pacifying (faster, more fluttery, little or no swallowing), you can gently take her off the nipple, lay her in her bed, and either allow her to fall asleep without sucking, or help her suck on thumb or pacifier if she prefers that. This may not work right away, but if you repeat this many, many times, your baby slowly but surely becomes able to do that final step of drifting off to sleep, without feeding while she does it. This helps her sleep longer at night, as well as take longer naps, because she doesn’t search for a nipple each time she comes into a light sleep or partially wakes up. You may hear advice saying to go ahead and let baby fall asleep while feeding, just wake her up before you put her in bed, but it’s much easier on your baby to catch her before she falls asleep. We adults all know how hard it can be to try to fall asleep twice!

3. Discern Your Baby’s Sounds

Babies are noisy! Why didn’t anyone warn you about the grunts, squawks, and gurgles your baby produces at night? One of the keys to promoting your newborn’s sleep development is to listen and discern your baby’s nighttime sounds.

Talking, whining, fussing, grunting, grumbling, kicking her legs, even pivoting and traveling around the crib—these are all normal noises and movements your baby will make as she figures out how to get comfortable and fall asleep again. These sounds don’t necessarily mean, “Come and get me, I need you!” so when you hear them, try to resist jumping to pick your baby up. Give her some space to work things out on her own. Your baby will wake up multiple times a night (as will your older child, and as do you). What matters is whether she can get settled and fall back to sleep again on her own. Wait, listen, and see if she can figure it out.

During REM sleep (also called “active sleep”), babies tend to twitch, move their arms and legs, make sounds, and breathe irregularly, and they can even open their eyes. Roughly 50 percent of infant sleep is active, so that can make for a lot of normal noises at night.

However, if your baby constantly snores, gasps, or snorts while sleeping, tell your pediatrician about this so he or she can make sure it’s not a sleep disorder such as sleep apnea.

DOES BABY NEED YOU, OR SHOULD YOU GIVE HIM SPACE?

Jane: I was convinced my 3-month-old was a problem sleeper; he was waking constantly. But in a baby group one day, another mom described how, when she started really listening to her baby’s sounds instead of rushing in, her baby’s sleep began to stretch out naturally. I came in to group the next week saying, “Never mind, my baby is actually a great sleeper. It was me who was getting in his way, interrupting him during all his grunts, squawks, and squirms!”

It can also help to keep in mind that not all cries are hunger cries. With a newborn, this may take some time to discern. If your baby has fed within the last 2 hours, this is a good opportunity to practice other methods of soothing. Building a repertoire of ways to calm your baby helps her become more flexible. It also loosens the association between food and comfort.

4. Use the Soothing Ladder to Avoid Overhelping

If your baby wakes up at night and needs you, be curious about the least intrusive thing you can do to help her fall back to sleep. Use the Soothing Ladder method to respond to your baby at night.

The Soothing Ladder Method

This method works for the first 4 to 5 months; the earlier you start, the better.

When your baby wakes up in the middle of the night, you use the Soothing Ladder to respond to her with the least intrusive means possible—by doing this, you respond to your baby but avoid overhelping. You start at the bottom of the ladder and spend roughly 30 seconds trying to soothe her, moving up a step if it doesn’t work. Maybe one night your baby is calmed by you patting and rubbing her back, but another night all she needs is a soft song or shushing. You won’t know unless you start from the bottom and take small steps up. Don’t swoop in with the “big guns” (usually a feeding) right away.

During these early months, if your baby wakes up and you think she’s due for a feeding, you’ll go up the steps of the Soothing Ladder fairly quickly, only spending about 10 to 15 seconds or less on each step before feeding her. By doing this, you are building space for your baby to grow into, when she’s eventually ready to drop that feeding. The goal is neither to rush her into dropping a feeding nor to continue assuming she needs to eat beyond the age when she really doesn’t need to anymore. Take a curious step back, just far enough for her to show you.

The Soothing Ladder Steps

Create your own ladder, based on what you know about your baby’s soothing needs. A typical sleep ladder for a young baby is:

7. Feeding her

6. Picking her up to gently rock until soothed but still awake

5. Jiggling baby in the bed

4. Your touch, patting on the back, rubbing head or tummy, hand over top of the head, and so forth

3. Replacing the pacifier and/or lovey

2. The sound of your voice, talking, singing, shushing

1. Your presence in the room

When your baby makes a sound at night, listen first (remember that babies are noisy but they aren’t always telling you they need you). If you decide that your baby isn’t just making normal rustling or squawking noises but is truly saying, “Come in here!” go in and use your Soothing Ladder. Start with number 1 on your list and spend around 15 to 30 seconds on each rung of the ladder until you get to the one that works. Do not feel compelled to go all the way up the ladder each time. You can stop when you notice your baby settling.

For example: You hear your baby cry out and you determine that this is a “come here!” cry. You go in and shush her, but she keeps crying, so you find her lovey and pat her on the back. If she starts to calm down, keep patting and shushing rather than picking her up. It’s better for your baby to fall back to sleep in her bed than to fall asleep back in your arms. If she’s in her own bed, the next time she wakes she won’t be surprised to find herself there.

We’ve heard so many parents say something like, “I need to go straight to the yoga ball and bounce her!” but when they create and use the Soothing Ladder, they’re amazed to see that a step farther down actually works. Each time this happens, it creates a new learning opportunity for the baby. New pathways in her brain are formed, practiced, and strengthened every time she has these experiences.

Use the Soothing Ladder to respond to your baby by the least intrusive means, so that you allow her sleep skills to gradually unfold.

Babies change so fast—what they need one week they may not need the next. The Soothing Ladder is the way to track sleep development and to follow your unique baby in each moment, rather than using a prescribed cookie-cutter strategy for all babies.

EVAN’S BOUNCING SLEEP ASSOCIATION

Ava: As Evan reached 2½ months, I was beyond exhausted. The amount of time I had to sit on the ball and bounce him back to sleep every night got longer and longer. When I started using the Soothing Ladder with him, I was truly astounded to find that Evan often only needed a few shushes or maybe a little back rub, not the full bouncing routine I thought he did! Over time, I rarely climbed past the first few rungs, and he began to do more soothing on his own.

5. Don’t Let Your Baby Cry for More Than a Minute

For the first 4 months, don’t let your baby cry for more than roughly a minute (one full minute might feel like more than that because it’s so hard to hear our babies cry!). The squawks and grunts are fine, but if your baby is truly crying, attend to her. By meeting your baby’s needs early on, you are building trust and a feeling that the world is a good place. In turn, your baby will relax and her stress level will remain low.

It’s important to know you can’t spoil your baby. Remember, this is how you build trust in the early months. Many parents, using this idea, discover that their baby predictably cries for about 30 to 45 seconds and then falls asleep almost every time. For these babies, crying is a form of stress release.

6. Daytime Independence

Look for moments during the day when your baby is enjoying hanging out by himself. Maybe he’s fascinated by a shadow on the wall, marveling over his own fingers, staring at the tree outside the window, making baby pterodactyl sounds, or practicing squirming and rolling. What is the most attuned thing you can do when your baby displays such contentment on her own? Absolutely nothing! Just wait, watch, and wonder. There are two sides to a balanced attachment—proximity and soothing on one side, and your sensitivity to when your baby is just fine on his own or maybe even struggling a little bit on the other. When you attune to these signs of independence during the day, you’re cultivating the same skill for nighttime. Remember that your baby’s internal attunement grows over time in the moments your baby is separate from you. This is when he can practice exploring and building confidence.

7. Transitional Object

More commonly called a lovey or blankie, this is an important aid for falling asleep and self-soothing for most babies. It’s helpful to think about it in two stages.

Stage 1 Keep it with you and your baby as much as possible, especially when you’re cuddling and feeding, so it has your scent and is associated with comfort (you could even sleep with the lovey for a few nights so it smells like Mom or Dad).

Stage 2 Once your baby shows signs of being attached to the lovey (rubbing it on his face, feeling it with her fingers, or grasping it), typically between 5 and 12 months of age, keep it in the crib for sleeping only, so she has a special way to soothe herself that evokes sleepy feelings. Keeping the lovey in the crib and using it only for sleep protects its “potency.” Babies are often very happy to get into bed and see their treasured lovey waiting for them.

A lovey is typically a small (size of a cloth diaper) blanket, cloth, or unstuffed animal. You can introduce the lovey any time you want (see “Safe Sleeping Practices” for more on safe loveys in the first 4 months), but generally, the sooner the better. For those babies who do attach to their lovey, the benefit to sleep is significant, and it can continue to help with sleep for years to come, both at home and when you travel. It’s a good idea to have multiples on hand.

8. Tummy Time

The connection between tummy time and sleep is huge. Regular tummy time will give your baby the strength and coordination she needs to roll, rotate, tuck her legs under her, or anything else she needs to do to get into a comfortable sleep position. When this happens, it’s a whole new world for your baby because she gets to choose her favorite body position instead of being stuck in the one you put her in. Lots of babies gravitate to belly sleeping, so once they can roll, they find their way to this preferred pose and sleep for longer stretches. It may feel unnerving to see your baby on her tummy for sleep, but once she can make it to this position on her own, it’s okay for her to stay there.

Tummy time gives the neck a workout, strengthens the trunk, and gives your baby more reaching and looking practice. But tummy time may help with more than just motor development—encouraging motor skills is also known to help babies with social development, since the stimulation to motor pathways in the brain seems to encourage growth in other regions as well. Seeing the world tummy-down and head-up also helps your baby to connect the sounds in her surroundings with their exact location (rather than being stuck looking at the ceiling). That’s also why carrying your baby is good for the brain—being in a bouncy seat or car seat all the time blocks her ability to turn, look, and see where all the noises in her world are coming from.

BENEFITS OF TUMMY TIME

Rolling and moving help enormously with sleep. Babies who can move get to choose their favorite sleep position; now they can get comfy like we do at night.
Babies spend a large portion of the day on their backs for safe sleeping, and in car seats, strollers, and other devices. All that back time needs to be consciously countered with belly time.
Being on the tummy strengthens the muscles of the neck and back.
The tummy position reduces the risk of developing a flat head.
Pressure on the tummy increases neurological organization, a fancy way of saying that it helps your baby to regulate and feel comfortable.
Being on the tummy aids in future fine motor skills, as little hands push and grow strong.
Tummy time is the first step in the natural progression to rolling, sitting, crawling, standing, and, eventually, walking. On the floor (whether on her back or belly), unaided by devices, should be baby’s “default” position.

TIPS FOR TUMMY TIME

Aim for 10 minutes per waking hour. If your baby can only last for 30 seconds in the beginning, just put her down frequently for those short bursts.
Instead of plopping your baby down directly on her tummy, start by placing her on the floor on her back. Look at her, smile, say something like, “I’m going to help you roll to your belly,” and roll her from the hips gently. (With repetition, she’ll learn what’s coming.) If her arm gets stuck underneath her, lift the hip on the same side of her body to allow her to pull her arm out. The idea is for your baby to participate in moving to her tummy instead of feeling like she’s been stuck there.
If your newborn is hopelessly face planting, use a small, rolled-up receiving blanket under her chest at armpit level, with her arms reaching forward. Feeding pillows are not a good idea as they give too much support and keep baby from the workout she needs.
Your baby’s favorite thing to look at is your face, so what better way to entertain her and “grow” tummy time than to get right down at eye level with her. Sing, make funny faces, and let her know that you know it’s hard.
Her second favorite thing to look at is her own face, so use a tilted mirror on the floor. See what happens when you put two babies face-to-face to gaze at each other.
Some tummy time can be right on your chest, as you lie flat. You can press your palms into your baby’s and help her push.
It’s okay for your baby to put her head down during tummy time. Think about how big and heavy her head is in proportion to her body; that’s a lot of gravity working against her. You can help your baby learn to turn her head to one side and the other; this will help her sleep easily on her tummy once she learns to roll.
Keep it positive. If you’ve done all you can to coax your baby into staying a few more seconds but she is clearly distressed, it’s time to roll her to her side or back, or pick her up and try again in a little while.
Don’t lose hope. Tummy time progression often feels like a flat line, followed by an epiphany, when the baby bursts into loving it. Eventually, this may become her favorite play position.

FLAT HEAD AND TORTICOLLIS

Many newborns have somewhat lopsided heads. This can occur while passing through the birth canal or after birth as a result of spending too much time in one position. Torticollis, where baby’s head is tilted or twisted to one side, usually because the muscles on one side of the neck are tighter, can also be the cause. Although being on their backs (until they can roll to tummy on their own) is absolutely the safest position for sleep, you can help avoid flat spots with some simple tips.

Caution: Don’t use rolled-up towels or positioners in the crib to get your baby to keep her head to one side. Never rest your baby’s head on a pillow or other type of soft bedding. These increase the risk of SIDS. Always start by checking with your pediatrician if you have concerns about your baby’s head shape.

Change Direction Place your baby on his back to sleep, but alternate the direction your baby’s head faces—place your baby’s head near the foot of the crib one day, the head of the crib the next.

Hold or Wear Your Baby Holding or wearing your baby when he is awake will help relieve pressure on his head from swings, flat surfaces, and car seats.

Frequent Tummy Time With close supervision, place your baby on his tummy on the floor, frequently, during waking hours.

Feeding Time Alternate sides when feeding baby a bottle. You will do this naturally when breast-feeding.

Get Creative Position your baby so that he will have to turn away from the flattened side of his head to look at you or to track movement or sound in the room. Move his crib occasionally to give him a new vantage point.

Varying a baby’s head position is typically enough to prevent or treat flat spots. If the flat spot doesn’t improve within a few months, your baby’s doctor might prescribe a special headband or molded helmet to help shape your baby’s head.

Naps and the 90-Minute Awake Window

Your Baby’s Naps

In the first 4 months, your baby will sleep in short and long stretches during the day—as short as 5 minutes and as long as 2 to 3 hours. You can see how newborn awake/asleep patterns progress in the figure in Chapter 8’s “When the Internal Clock Develops.”

Little baby naps typically start out luxuriously long. The tug of sleep is so strong for a very small baby that 2- to 3-hour siestas are common. Enjoy this—shower, eat, read, take a nap yourself. Don’t worry too much that your newborn is sleeping heavily during the day because it typically doesn’t correlate with restless nights. Just make sure that your baby is exposed to some indirect sunlight and activity during the day, with quiet and dark at night. Soon, her body will adjust.

Your young baby does not need (nor is her body ready for) a nap schedule until she is roughly 5 to 7 months old. Your goal during the first 4 months is to allow her ample opportunities to nap, to understand her sleep needs and how long she can be awake, and to encourage self-soothing. You can look forward to Chapter 4 for specific schedules for when your baby is a little older.

The 90-Minute Awake Span

Because of your baby’s strong sleep drive (see Chapter 8), after about the age of 2 months, she will start to feel drowsy around 90 minutes after waking up (before this age, she’ll flicker in and out of sleep much more quickly). There is a magical little window here when falling asleep is easy. When you’ve missed the window and she’s overtired, she may yawn, pull her ears, rub her eyes, cry, or appear a little wired. At this point, falling asleep becomes more difficult because her nervous system is overwhelmed and dysregulated. This 90-minute rule of thumb applies to the start of your baby’s day, and also to each window of time she’s awake after a nap, throughout the day.

The 90-minute awake span is one of the most successful ways to improve naps and, as a result, all sleep. Sleep begets sleep. One of the most common mistakes parents make is not putting baby down to nap often enough, which results in a chronically overtired baby whose nervous system is overstimulated and who is even less capable of falling asleep. Don’t fall into thinking that the longer you keep your baby up, the more easily she’ll fall asleep. Many parents assume that their baby is fussy as a result of hunger or boredom, and they try to feed and entertain their baby. Sometimes this is true, but often when your baby is fussy, it’s because she’s overtired.

THE 90-MINUTE STEPS

Roughly 75 minutes after your baby wakes up (for the day or from her last nap) or whenever you see the subtle cues listed below, start a simple, soothing, 15-minute naptime routine.
At the 90-minute mark, put your baby down. Parents are continually shocked and thrilled by how much this helps.
Even if your baby only naps for 15 minutes, the 90-minute rule usually still applies from the time she blinks awake. Remember this if you’re on a stroller walk or in the car and your baby catnaps.

Around 2 to 3 months of age, it is common for babies to sleep in short, brief bursts. If your baby takes frequent catnaps, don’t feel as though you must do a full naptime routine before each nap. You might sing her a song while you put her down in her regular sleeping place, take her for a walk, or just put her in the sling or carrier in the house to allow her to doze. When your baby is 3 months and older, the naptime routines become more important.

These are early, subtler cues for sleepiness around naps. If you look closely, you may start to notice these (but we recommend starting with the more mechanical tool of watching the clock).

staring off into space, dazed look in eyes
reduced activity
less interest in surroundings

The 90-minute rule isn’t rigid; you have some wiggle room. Often the first nap of the day can come very easily after only 60 minutes of awake time. (Remember that the first nap is also often the easiest one to practice putting baby down a little awake). If you see that your 0- to 4-month-old baby seems tired, even though 90 minutes have not passed, it’s best to follow these cues and put her down to sleep. Like everything else, this 90-minute span will grow and change as your baby quickly matures. For the first 3 to 5 months, the 90-minute rule will be very helpful. If you feel your baby is growing out of the 90-minute rule, see Chapter 4 for older baby nap routines and schedules.

90-MINUTE AWAKE SPAN HELPS AVA WITH LONGER NAPS

Allison: We were struggling with naps. I was putting Ava down way too late, after 2 to 3 hours of being awake, which was too long for her. I now put her down 90 minutes after she is awake, and no more than 2 hours. She has been napping anywhere from 1 to 2 hours, which is a huge difference from previously napping 20 to 40 minutes. Especially in the morning: she wakes up around 6:30 a.m. and we have breakfast and play and around 8:00 a.m. I know she’s tired. I sing her a song as I put her down and it still takes her 20 minutes of talking/playing in her crib and then she sleeps.

Catnaps

Short naps are really common. Around 2 to 4 months, your baby will be awake for longer stretches. At this point, it’s typical for babies to catnap—sleeping for 20 to 30 minutes (just enough time for you to grab a snack, check your e-mail, or take a shower, but not enough time to do all three)—and then pop awake, ready to play again. One reason this happens is that we have to put babies down on their backs to sleep, and they easily startle and wake themselves up in this position. When your baby comes into a light sleep, it can be more difficult for him to go into a deep sleep again in a back-sleeping position. This makes belly sleeping a tempting notion, but remember that research shows putting baby to sleep on his back lowers the risk of SIDS significantly. Soon your baby will be rolling and moving on his own to the most comfy sleep position. Once that happens, the length of his naps will grow to a span of 1 to 3 hours. If you’d like to see where your baby’s daytime sleep will be later on, you can look at Chapter 4 for older baby nap schedule examples.

Remember that even a catnap counts when it comes to the 90-minute awake span. Short naps may still relieve your baby’s drowsiness (and release the built-up pressure of his sleep drive, described in Chapter 8) enough so that he won’t go back to sleep again—it’s like a power nap.

Where Should Baby Nap?

Little babies often sleep better and longer when they’re being held or carried. Put a sleeping newborn down on a flat surface and bam, he stirs awake! Nestle him in your arms or put him in the sling and he sleeps for hours. This is common and normal. Your baby doesn’t want to be in a motionless, flat environment, but this will change over time. Allow your baby to sleep where you feel it works best, just keep in mind that it’s really helpful to have him practice napping in his regular sleeping place, too (his bassinet, co-sleeper, or crib); aim to put your baby down for a nap in his regular sleeping place at least once a day. Often the first nap of the day is the easiest one to practice this.

NAPPING ONLY IN MAMA’S ARMS

Mona: Evan basically refused to sleep for more than 15 to 30 minutes at a time during the day unless I was holding him. If he was in his crib, forget it, I’d go through all the trouble of getting him to sleep, only to have him pop back awake again, whereas if I put him in the carrier or just held him continuously, he’d sleep for hours. I made it my goal to put him in his co-sleeper for his morning nap and that way I knew he had at least some practice there (the rest of the time, I mostly carried him). That morning nap grew into a nice long one, and eventually he started taking all naps in his crib.

QUICK LIST: NAP TIPS

1. The 90-minute rule. Your baby will be ready for sleep after roughly 90 minutes of awake time in the morning and after each nap. Watch the clock and start your 15-minute naptime routine 75 minutes after her last awakening so that you can put her down at the 90-minute mark. Don’t miss the optimal window—when your baby is overtired, it’s harder for her to fall asleep. The 90 minutes is adjustable because every baby is different and the span grows over time.

2. Naptime routine. This will be similar to the bedtime routine (but shorter) and consistent each day. Don’t skip the routine. Be sure to put it into place before your baby seems to need it. The nap routine becomes more important as your baby nears 3 months.

3. Early sleepiness cues. Babies show signs of sleepiness like becoming still or staring into space before they start to yawn and rub their eyes. It’s good to know these early cues so that you can start winding your baby down before she is overtired.

4. Feedings. Be creative about getting the recommended number of feedings in. Naps and feedings will naturally be erratic at this age and it’s better to follow your baby’s lead and feed on demand. If your baby takes a long nap, don’t wake her for a feeding, just try to make up for that feeding at another time.

5. Room environment. Make the room where baby sleeps dark and quiet for naps. Use blackout shades. White noise, like nature sounds or a low fan, is very calming, especially during the first 3 to 4 months.

6. Cues from you. Give baby the genuine feeling that naptime is a rest time for you as well—put on a pajama top, prepare to lie down, even for only 10 minutes. If baby senses your anxiety about all you want to accomplish during the nap, she will have a hard time settling down.

7. Rest versus nap. It’s okay if your baby sometimes just rests (happy in her bed) during naptime—also, a short nap should be perceived as a successful one.

Fussiness, the Witching Hour, and Colic

Fussiness and the Witching Hour

Most young babies have times during the day when they seem uncomfortable, cry, or fuss more than usual. There are lots of possible reasons for this: immature nervous system, overstimulation, understimulation, hunger, gas . . . the list goes on. A fussy baby is often a tired baby, though. Remember that little babies can really only be awake for about 90 minutes before they start to become drowsy, and for babies roughly 2 months and older, the 6:00 to 7:00 p.m. hour is when they’re actually ready for bed. Even if your baby follows these guidelines, she may still feel tired and become fussy as a signal that she’s ready to sleep.

Put your baby down after every 90-minute span of awake time throughout the day.
If your baby is 6 weeks or older and seems to be drowsy and has a longer stretch of sleep in the early evening, consider an early bedtime, around 6:30 to 7:00 p.m.

Many parents notice that their baby becomes extra fussy in the late afternoon and early evening (some parents can literally set their clocks by when the crying and fussing begins). This “witching hour” could be a result of a baby’s accumulated stimulation from the day. Her nervous system and her internal clock are still developing, so she’s getting conflicting messages from her own body: “I’m tired! No, I’m alert! . . . Sleep! Wake!” This often means that your baby needs more sleep, but, counterintuitively, she may be harder to put to sleep. Your baby can’t yet balance and integrate all those bodily signals and, as a result, she may have times when she cries no matter what you do.

The witching hour will pass eventually, as your baby matures. In the meantime you can try to:

Take your baby outside for a walk in a carrier or stroller. The fresh air, distraction, noise, and motion really help.
Reduce stimulation like bright overhead lighting as the evening progresses.
Allow your breast-feeding baby to “cluster feed” or feed continuously or frequently during the late afternoon. Some babies even need feeding and motion at once during this difficult time. Try breast-feeding while bouncing on a yoga ball or rocking/walking around the house if you can manage these two feats at once.

Colic

All babies cry, but approximately one in five babies (that’s really quite a few—20 percent) are described as having colic and will cry piercingly and inconsolably for hours at a time, no matter what you do.

Colic is often defined by the “rule of three”: crying at least 3 hours per day, more than three days per week, for three weeks’ duration or more (some have debated this strict definition as many babies have colic but won’t reach the 3-hour crying mark). Colic is the name given to this extreme crying when it is unexplained—there is no identifiable cause (although there are plenty of theories, such as an easily overwhelmed and immature nervous system, or incomplete development of the normal, or “good,” bacteria in the gut). A hallmark feature of colic is that not much you try seems to make any lasting difference, and understandably, this can be at turns defeating, depressing, exhausting, and maddening for parents, who often feel alone and out of control.

Definitely call your pediatrician to talk about your baby’s symptoms and determine if they fall into the category of colic, or if there’s something else going on. If it is colic, the good news is that it does get better—in fact, it almost always seems to disappear magically (and thankfully) by 4 months of age. Babies seem remarkably fine once colic symptoms subside, but parents are often left with an almost “post-trauma” feeling from the experience.

Soothing Ideas for the Witching Hour and Colic

If your baby is very fussy or has colic, it may seem like there’s no end in sight, but know that things will improve. The biggest priority for you as an exhausted parent is to get the support and empathy you need to get through this incredibly challenging time.

Try different approaches, including wearing your baby in a carrier, swinging or bouncing on a yoga ball, using different-sized bottle nipples, adjusting the diet of the breast-feeding mother (with your pediatrician’s guidance), giving probiotic drops, applying pressure on baby’s belly, giving the baby a warm bath, swaddling, taking baby outside, playing music, turning on white noise machine, taking long car rides—the list is endless. Remember, it’s not uncommon that the crying will continue no matter what you do. Feelings of helplessness and extreme frustration are completely normal.
Get plenty of regular support. Trade off with your partner, hire a babysitter if you can, or enlist a friend or family member to give you regular breaks.
Find a new baby group to join. You will surely find someone in the same boat as you and you will no longer feel alone.
Do whatever it takes during this period to try to get your baby to take regular, frequent naps and sleep as well as possible at night. She’ll need extra help from you to regulate and get the sleep she needs during the difficult period, and in turn the payoff will be a healthier and stronger brain and body.

There’s no reason to worry that a baby who previously had colic or was very fussy will have a harder time self-soothing and sleeping independently in the long run—these skills may just come a little later, once the symptoms subside. When they do, your baby will surprise you by how quickly she is able to catch up and sleep well. Don’t despair—even though she’ll have strong associations to you soothing her (because she truly needs a lot of help), when her symptoms go away you will be able to transfer this role to her.

Sleep Regression

Most parents expect sleep to get progressively better and better in the first 4 months, but if your baby didn’t get that memo, you’re not alone. Baby sleep is bumpy. It doesn’t follow a nice, logical path. Sleep improves and then regresses in fits and spurts: a few blessedly restful nights of long stretches, followed by a few nights of repeated wakings.

Around 3 to 4 months in particular, many babies hit a rough patch with sleep; even those who are champion sleepers as newborns sometimes start to wake up more frequently at this age. It can be frustrating and confusing for parents, who keep hearing that things get easier at 3 months, only to find their infant wide-eyed at 2:00 a.m. You can’t imagine how many times we’ve heard moms and dads exclaim about their 4-month-old, “He thinks he’s a newborn again!”

If this sounds familiar, don’t worry. The reason for the return of restless nights at this age is probably your baby’s rapidly developing brain (in other words, there is a silver lining). The drowsy cloud of the newborn months has worn off and your baby is leaping forward into a new level of consciousness. She’s more aware and capable now; there’s so much to do and see and explore.

SLEEP REGRESSION AND THE COGNITIVE SURGE

Cara: I was pretty happy since little Alexander was sleeping for longer and longer stretches at night. I was still nursing him to sleep and didn’t really think it was a problem because his sleep kept improving. Then, at 3 months and 3 weeks, everything changed. After a 4-to-5-hour stretch, he began waking several times a night, wide awake and clearly ready to party. My husband and I were really surprised by this and quickly exhausted, just like we were at the very beginning. We didn’t realize how all that nursing and holding to sleep would become an obstacle to Alexander’s sleep as he got older. Eventually we used the Sleep Wave to help him practice falling asleep on his own and his sleep got better again.

Review all of the steps in “Encouraging Self-Soothing” so that you can give your baby space to practice and make it through sleep regressions without developing a new sleep association (this is often really hard with a baby who is over 4 to 5 months old, which is why in the next chapter we present a clearer and more structured way to improve sleep for older babies).

A common misperception is that these sleep regressions always signal a growth spurt, which results in parents adding more night feedings. Try to avoid doing this automatically because this is the age when your baby is moving steadily toward getting all of the calories she needs during the day (if you do end up adding feedings, in Chapter 4 we can help you wean baby from these extra feedings). Use your Soothing Ladder and see if you can help your baby back to sleep with another method, unless you determine she is definitely hungry. The tricky part is that the same awareness that makes for bumpy nights may also make your baby distracted during daytime feedings (you probably notice her popping off the breast or bottle to check out her surroundings or feeding for just a few minutes before moving on to a new activity). Move to a calm and low-stimulus area like a dark bedroom for daytime feedings whenever possible, to make sure your baby gets enough to eat during the day.

The novelty of this higher level of awareness will eventually wear off. You will make it to 5 to 6 months and we’ll be ready to help you solve any nighttime dilemma you still find yourself in. Just hang in there through sleep regressions—they eventually pass.

Although sleep regressions are often developmental, if they persist, talk to your doctor and rule out or address medical problems such as reflux, ear infections, teething, allergies, and colic.

Breast- or Bottle-Feeding and Sleep

The pattern of your baby’s feedings will change during the first 4 months, right along with the rest of her development. This is the period of the most rapid consolidation of nighttime sleep, which means that over time the frequency of night feedings will decrease (although not always in a linear progression). At this age, your baby will wake up because she’s hungry, but she’ll also naturally wake up frequently because her nervous system and internal clock are immature.

We don’t recommend that you purposely try to wean your baby from nighttime feedings during the first 4 months. It’s incredibly natural (and important for breast-feeding) that your baby eat at night, so it’s best to follow your baby’s lead. In the next chapter, when your baby is at least 5 months of age, we’ll guide you through how to wean her from night feedings if you want to.

Breast-fed babies are not worse sleepers! Neither formula nor solid foods will help your baby sleep—this is a myth. Breast-fed babies may be more likely to fall asleep while eating, though, so they can quickly create a strong association between nursing and sleeping. If your baby falls asleep while eating, she’s more likely to wake up later and call for you to help her fall back to sleep.

Feeding at Night

1 to 6 Weeks

Doctors recommend feeding your baby 8 to 12 times in a 24-hour period, which usually means every 2 to 3 hours when awake. Your doctor may advise waking your baby to feed if she has slept more than 4 hours at any time, until she has regained her birth weight, after which time you no longer need to wake her. The most reliable indicator that your baby is getting enough to eat is the progression of her growth.
Look for early cues that your baby is ready to feed, such as increased alertness, physical activity, mouthing, or rooting, rather than waiting for crying, which can be a late sign of hunger.
It’s normal for baby’s feeding and sleeping patterns to be erratic during these early weeks as her nervous system is still immature. During this time, if you’re breast-feeding, it’s best to feed your baby on demand rather than trying to impose a schedule for feedings—this follows your baby’s development and is the best practice for ensuring your milk supply.
It’s important to remember that waking doesn’t equal hunger. If you have fed your baby within the last 1 to 2 hours and she wakes at night, this is a good opportunity to broaden her repertoire of soothing (see the Soothing Ladder). On the other hand, if your baby wakes after 3 to 4 hours, or at a time when she usually feeds, you can move up the Soothing Ladder quickly, confident that your baby is ready to eat.

6 Weeks to 4 Months

It’s normal to see the frequency of nighttime feeding gradually decrease during this time, as your baby starts to sleep for longer stretches. Your baby’s digestive system is becoming more mature along with the organization of his brain and nervous system, two crucial areas of development that directly support sleep. Overall, your baby is taking in the same amount of milk, but gradually shifting those calories to the daytime.
By 2 to 3 months of age, it is reasonable to assume that two to three feedings during the night are enough for most babies. By 4 months, one to two middle-of-the-night feedings are enough for most babies.
At this age, if you have fed your baby within the last 1 to 3 hours and he wakes at night, this is a good opportunity to broaden his repertoire of soothing by trying other ways to help him get back to sleep.
Around 3 to 5 months, it is common for babies to temporarily wake up more frequently—ready to play and excited at the novelty of their new awareness. It’s natural to mistake this as a growth spurt and add in night feedings. As you know, babies rarely turn down an offer of milk during the night, so his eagerness to feed is not an accurate indicator of hunger. Review “Sleep Regression”.

CLUSTER FEEDING

It’s common for babies to feed more frequently during the several hours before bedtime. This is called cluster feeding and appears to be a way for babies to soothe and regulate their nervous systems in preparation for their night, rather than being a stocking up of their milk supply. Some parents choose to give a bottle of pumped milk to breast-fed babies for their last feeding of the day as Mom’s supply may be low at this time of day. If you do this, just remember to pump during this feeding time, or eventually it will lead to a further decrease in milk at this hour.

Introduce a Bottle

If you’re breast-feeding, it’s really helpful to introduce a bottle of pumped breast milk between 2 and 4 weeks and give baby a bottle every single day thereafter. If we had a nickel for every parent who stops offering a daily bottle to baby—figuring the baby has it mastered—only to see the baby refuse a bottle down the road! It’s so much easier to give a bottle every day than it is to turn around a refusal. Having your baby well-versed in bottle-feeding gives you the freedom to know that other people can care for her and handle her bedtime or nap routine. It allows you a break, and gives someone else the experience of feeding. In many families, this becomes a special time for the non-breast-feeding partner to bond with baby.

To prevent overfeeding, keep in mind that most babies don’t need more than 5 ounces in one feeding, no matter their age.

GENERAL TIPS FOR INTRODUCING A BOTTLE

Select a slow-flow nipple so that your baby has to work a bit. This mimics natural pacing and lowers the risk that she will come to prefer the bottle if you’re breast-feeding.
Hold your baby in an almost upright position while holding the bottle almost horizontal, tipped just enough to fill the nipple with milk. Keep gravity from speeding the flow of milk, again mimicking the pacing of the breast as much as possible.
Encourage your baby to participate by lightly brushing his lips with the tip of the nipple. When he opens wide, place the entire nipple into his mouth so that his lips rest on the base.
A bottle-feeding should take about 15 to 20 minutes. If it’s much faster or slower, you may have to adjust the nipple size and/or pace the feed. It’s very effective for younger babies and those with colic or reflux to pause and remove the bottle after 12 to 22 swallows for baby to breathe three to five times. Signs that flow is too fast include wide eyes, splayed hands, gulping, gasping, milk leaking from the mouth, and pulling off the bottle.
With a newborn baby, bottle-feeding can start small, at 1 to 3 ounces, building gradually to no more than 5 ounces at a time, as your baby grows.
Enjoy this time together. Hold your baby close, skin to skin when possible. Look for moments to lock eyes and chitchat or sing a soft song.

TIPS FOR HELPING BABY WHO REFUSES THE BOTTLE

Not Mom. Often the smell of breast milk and all the associations of Mom make it much more challenging for baby to go for the bottle. Dad or another caretaker can sometimes, with patience, find success. Sometimes Mom has to leave the room completely.
Change the scene. If you’ve been re-creating the familiar place and position used in breast-feeding, try the opposite. Walk around the house or outside, sing, dance, and try different positions. Hold baby on your chest facing out, or prop her up facing you on your lap. Don’t feed your baby when she’s lying flat on her back and never prop the bottle.
Bait and switch. You can try starting on the breast or pacifier and then gently switch to the bottle after your first letdown or once your baby is sleepy or relaxed. It can also help if he is not ravenously hungry. You might notice that your baby will take a bottle when he has just woken up.
Persist. Don’t give up. We meet very few babies who truly never take the bottle, as long as the parents keep trying (sometimes it takes a month or more). Try once or twice a day, ideally at the same times, and when everyone is relaxed and calm. Your baby will pick up on any pressure or frustration you’re feeling, so breathe; center yourself; and know that with time, persistence, and patience, your baby will eventually take the bottle.

Sleep and Your Milk Supply

If you are breast-feeding and your baby naturally drops a nighttime feeding, it’s a good idea to pump at the usual time of that feeding for a few nights and then gradually wean from that pumping. An abrupt decline in demand at a certain time can decrease your overall milk supply and cause discomfort for Mom.

Depending on how much milk your breasts are able to store, you may eventually go for 7 to 8 hours without feeding or pumping. Many moms will pump right before they go to sleep and then either feed or pump again 7 to 8 hours later.

Once your baby is sleeping for longer stretches, it’s a good idea to add a daytime pumping session or two if your storage volume is on the low side and you’re going back to work, for example. Often, 30 to 60 minutes after the first feeding of the day is the most productive time to pump.

Dream Feeding

Although our first choice is to let baby’s sleep unfold naturally, for some babies the “dream feed” technique works very well. Here’s how it works: While he’s sleeping, gently pick up your baby from his sleeping place (but don’t wake him) and feed him before you go to bed. For example, if you put your baby down at 7:30 p.m., you might try dream feeding him at 10:00 or 11:00 p.m. before going to bed yourself. It takes a few days for babies to get the hang of this pattern, but most babies will latch on and eat without fully waking up. If you try this for a few nights to a week, it may help your baby sleep a longer stretch. On the other hand, if you find that your baby wakes up for her next feeding at the same time no matter what you do, drop the dream feed and go back to letting your baby tell you when he’s ready to eat.

Parent Sleep: Help in the First 4 Months

We dedicate Chapter 7 to an in-depth look at helping parents (with children of all ages) sleep better. We recommend looking at the tips in Chapter 7 now, but here are additional suggestions for getting the most shut-eye possible during the newborn period.

Rotate: If possible, spread the responsibility for feedings and soothing so each parent gets a turn at a good solid stretch of sleep (even if it’s only 3 to 4 hours). Have one parent or helper give a bottle once in a while at night so that the other parent can sleep through a feeding. If you’re nursing, pump before bed and leave a bottle in the fridge, so that person can scoot out quickly to grab it.
Enlist help: You cannot do this alone. Nor should you try. Hire a babysitter, ask a trusted friend, hand your baby to Grandma—call on your support system for help. You may feel as though no one but you is capable of taking care of your baby, but other people will find their own ways. It’s worth it to relinquish control for a bit and take care of yourself. It’s also a good thing for your baby to develop trust in multiple caregivers. If you’re a single parent, try to schedule helpers, family members, or friends on a regular basis to help you through these early months.
Separate for sleep: If your home allows, temporarily assign one partner to another sleep space for all or part of the night, or have one parent take the baby into another room in the early morning so the other can sleep. Mom or Dad might sleep in the guest bed or on the sofa one night (or for a portion of the night) for uninterrupted sleep.
Block noise: The parent brain is easily aroused with the tiniest baby peep (especially for a night-feeding mom), so run a fan in the guest room while you or your partner escape there to sleep. Whether you’re in the guest room, living room, or right next to your partner in bed, use earplugs if you are the one off duty.
Nap: The traditional wisdom is to “sleep when the baby sleeps.” We have mixed feelings about this advice. For some new parents, it’s a lifesaver. For others, it makes them feel even more disoriented and groggy to sleep during the day. Experiment and see which category you fall into.

If you feel like you can’t wind down and sleep, or even really rest while your baby is napping or sleeping, you’re not alone. It’s normal to feel some combination of excitement, anxiety, shock, and fatigue like you’ve never felt before. This is a good time to begin to practice some simple breathing and mindfulness techniques (see the Appendix) to help your nervous system come back to a balanced state, so your body can rest.

Postpartum Emotions

New parenthood is naturally a time of challenging emotional swings from joy at the miracle of your baby, to sadness or anxiety at the abrupt loss of the life you knew and the overwhelming tasks of parenting. It’s normal to feel that, at every turn, you don’t really know what to do, the Groundhog Day sense of no end in sight, and the mind-numbing heaviness of sleep deprivation. Most parents can identify with the feeling of being moody and blue, at the very least. These feelings are normal for all parents.

Around 20 percent of mothers experience postpartum depression, anxiety, or a combination of the two, making it the number one complication of childbirth. It can appear anytime within the 12 months after birth. Postpartum depression and/or anxiety can feel like it takes over a mother’s thoughts and behavior in a strong and unfamiliar way, which can make it scary and hard for her to talk about.

The great news is that postpartum depression and anxiety are very treatable with expert therapy, support groups, and sometimes medication. We’re happy to see the stigma and secrecy of postpartum challenges fade away, as society begins to understand it better. More and more moms are reaching out for help and feeling better much sooner.

Sleep deprivation and worry about baby’s sleep can contribute to postpartum issues. We find, in our practice, that improving both baby’s and Mom’s sleep can help moms start to feel more like themselves again. Sleep deprivation is not to be taken lightly and, like other features of postpartum depression and anxiety, it is definitely treatable. We’d love all moms to discuss postpartum emotions with their doctors, families, friends, and therapists to determine what level of support they need.

If you think you might need support during your pregnancy or postpartum, help and information is available through Postpartum Support International (www.postpartum.net; 1-800-944-4773).

TROUBLESHOOTING SLEEP

When Should I Move My Baby to Her Own Room?

For frequent feedings and bonding during the early months and also due to the recommendation by the American Academy of Pediatrics that newborns should co-sleep (in the same room as the parents but on a separate sleep surface) as a SIDS precaution, starting out with baby in your room is a good idea. Since babies’ highest risk for SIDS is before 3 to 4 months, a good time to move your baby to her own room is around 4 to 6 months. It’s a personal decision that can be influenced by your baby’s growing awareness of and activation by your presence in the room, as well as your desire to have your personal space back. However, if you, your partner, and your baby are all sleeping well in your room and you have no desire to move her yet, that’s perfectly fine as well.

Should We Have a Schedule?

Not yet! You baby’s nervous system, circadian rhythm, digestive system, and more are not mature. This is a time in your baby’s development to follow her lead, feed on demand, and follow simple guidelines like helping her nap (after about 2 or 3 months of age), after roughly every 90 minutes of awake time.

My Baby Is Rolling to His Tummy in Bed. What Do I Do?

When your baby first rolls to his tummy in the crib, he will very likely get frustrated and seem unhappy—really he’s just unfamiliar with the position and might feel stuck and uncomfortable at first. If this happens, you will initially feel compelled to turn your baby over to his back right away, but this is often a losing battle of flipping and reflipping through the night.

Trust us, this tummy-rolling business is ultimately a very good thing. Help your baby weather this feeling of unfamiliarity by leaving him on his tummy and using the Soothing Ladder. Work your way up the ladder, just as you would at bedtime or with any awakening. This transition is similar to un-swaddling in that you will have a few bumpy nights, but when the novelty wears off, the end result will be a big step toward improved sleep. Most babies sleep better once they’ve found their way to their tummies, as their limbs are now contained and the pressure on their bellies is calming. The long-term goal is for your baby to find a comfortable sleep position without your help. Lots of tummy time during the day will help your baby feel more familiar with this position. It can also help to show your baby how to turn his head to the side instead of just face planting. For safety reasons, it’s best to always put baby down on his back. Remember that if your baby can roll to his tummy, for safety reasons, it’s time to get rid of the swaddle.

3-MONTH-OLD FLIPPING TO HIS TUMMY

Rachel: Wesley kept ending up on his belly and it made me nervous, so I kept flipping him to his back, even though I knew he’d roll right back to his tummy. I had the feeling that he liked it better if he got to his belly himself. Sure enough, pretty soon, Wesley was rolling to his tummy midair as I lowered him to the crib!

Is teething waking my baby up?

While the normal age range for teething to start is broad (we once had a mom in class who was born with a tooth, and we’ve also heard of babies who got their first chomper at 14 months), the majority of babies sprout their first tooth between 4 and 7 months. What typically precedes the appearance of a tooth is a prolonged period of drooling, chewing on everything, and a range of very low to mild discomfort and fussiness.

It’s normal to be unsure whether teething is causing your baby to wake up (if only she could just tell you!). If you’re noticing extra fussiness during the day and decreased interest in feeding, and you can see little clear or whitish bumps (the bottom middle and top middle teeth, in that order, are typically the first to come in), there’s a pretty good chance that your baby is about to cut a tooth. Don’t assume that teething is going to bother your baby a lot. Quite a few babies will sail through teething without any significant sleep disruption, while others are noticeably bothered during the night.

If your baby is actively cutting a tooth (meaning it’s currently coming through the gums), and sleep has clearly been derailed, consider addressing the pain so that he can get good sleep during the two to three days it usually takes. Talk to your pediatrician about giving a pain medication thirty minutes before bedtime, and make sure you use the correct dose. You can also use homeopathic remedies or whatever you have found to be helpful—just be sure to clear this with your doctor. By addressing the pain during the two to three nights of active cutting, you are helping your baby to get the sleep he needs so that he can better tolerate the pain during the day, without adding sleep deprivation to his plate. It will also prevent you from overhelping him during the night, which can quickly create new unhelpful sleep associations. Acute teething pain usually lasts no more than two to three days, so try to be aware of not assuming that your baby needs more help at night for weeks because of teething.

Babies may have a tendency to take in less milk during the day, when actively teething. You can avoid adding nighttime feedings by assuring that they feed well during the day.

TEETHING TIP

Give your baby a cold, wet washcloth or gel-filled teether to chew on before daytime feedings. The coolness (avoid the freezer as it can be too cold) can help to numb her gums a bit and up the chances that she’ll have a full feeding.

My baby will sleep only in a swing, vibrating chair, hammock, or other device. Is this okay? Will he ever sleep in his crib?

You’ve probably heard the term “fourth trimester,” which refers to your baby’s first 3 months out in the world. This term came about as a way of describing how we humans come into the world less mature than many other species, due to the size of our brains. This means that simulating the environment in the womb can be extremely helpful for soothing and sleep, and this is why many 0-to-3-month-old babies respond so well to rocking, bouncing, and swinging.

If these devices work in the first 3 months, use them to soothe your baby and try not to worry too much about the future. Remember that during these early months, responding to your baby’s cues when she needs your help is key to her feeling that the world is a safe place where her needs are met. At the same time, stay curious about her abilities so that you can discover when your baby is able to fall asleep without the help of these devices. With this mind-set, your baby will show you when she doesn’t need as much help anymore.

This early need for movement is finite—it won’t last. As their brains quickly mature, babies are ready for the next step and will sleep better without the movement, just like we do. Review the steps in “Encouraging Self-Soothing”. One of the most common responses to our sleep approach is, “Wow, I didn’t know my baby was so capable!” If your baby is still reliant on movement to fall asleep when she reaches 5 months, we will help you change this pattern in the next chapter.

My baby is sick. What to do during the night?

Sniffles, tummy upset, ear infections—babies can pick up all kinds of bugs and viruses. As much as we wish we could protect them from illness, we know that exposure to these colds and flus is a big part of what stimulates their immune system to become strong and resilient.

When you know your baby is sick and he wakes during the night, attend to him promptly and do whatever he needs to feel soothed and comfortable. This part isn’t difficult for most parents; the hard part is giving baby space again once he’s feeling better. You may notice that your baby’s sleep patterns are bumpy for a few nights, even after the illness passes. Go back to your methods for encouraging self-soothing and give your baby a little space to show you what he can do now that he’s feeling better.

It’s a good idea to always check with your pediatrician before you give your baby any medications, even those sold over the counter, and make sure that you understand the dosage and directions. Even when your baby is sick, all of the safe sleeping rules still apply, including no pillows or blankets or anything other than their lovey in the crib.

Why does my baby take super-short naps?

Babies evolve from the super-sleepy newborn state—when naps go on and on—to a more aware and conscious state. After this happens, they are more likely to fully awaken when they transition into a light sleep. More babies than not will move to these alarmingly short catnaps of about 30 minutes, anytime between about 2 and 6 months of age. Once your baby’s brain and body mature even more and she can roll to her favorite sleep position, her naps will lengthen again. The tips most likely to support your baby’s progress toward longer naps are:

Put your baby down awake.
Discern your baby’s sounds (at the end of a short nap, don’t rush in!).
Give your baby plenty of tummy time between naps.

Some parents have success using the Soothing Ladder at the end of a very short nap to get baby back to sleep quickly to “finish” their nap. This is always a good thing to try from time to time, as the day will come when your baby is ready to stretch out that nap. In the meantime, during the catnap phase, don’t worry, and know that it’s perfectly normal. Just watch the clock and put your baby down 90 minutes after her last awakening. This is a very challenging time, as your day feels endlessly consumed with naps and feeding and little else. It’s fine to have some of these naps take place in the car, carrier, or stroller, so that you can get out and walk, do errands, meet a friend for coffee, or go to a class.

Can my baby just nap on the go?

As your baby approaches the 3-to-4-month mark, you may notice her having a harder time sleeping when out of the house. Again, this is because her brain is developing and her awareness and interest in the world are growing steadily. She is much more curious and stimulated by her environment, and this makes those peaceful restaurant meals, with baby sleeping soundly by your side, more difficult. The world is just too exciting now and she needs her familiar cues and nonstimulating environment to fall asleep, just like you probably do. Of course, we all know someone who can fall asleep anywhere, at the drop of a hat; there’s always a chance that you have a baby like that, but it’s not the norm.

My baby woke up after just 45 minutes of going to bed!

Babies and young children often have a brief arousal roughly 1 hour after falling asleep (most likely because they move from quiet to active sleep during this time). If you hear from your baby 30 to 60 minutes after she goes to bed, it’s likely because she hasn’t yet practiced self-soothing back to sleep. Try putting her down awake at the beginning of the night, or for her first nap, and using other steps explained in “Encouraging Self-Soothing”. If she really cries out, use the Soothing Ladder to help her.

My baby has reflux. What do I do for sleep?

The range of reflux symptoms is broad, from the “happy spitter” all the way to GERD (gastroesophageal reflux disease), the most severe form of acid reflux. Always start by working with your pediatrician or specialist (pediatric gastroenterologist) to determine the best treatment protocol for your baby. Some doctors may recommend a particular sleeping position for your baby, so talk to yours and review the safest way to help your baby get comfortable for sleep.

Depending on the severity and progression of your baby’s reflux (with treatment and over time, symptoms will subside), you may see sleep development unfold more slowly. The Soothing Ladder allows you to follow your unique baby, but it may take more time if she has reflux. You might practice putting her down a little awake only once a day or at bedtime, until her reflux starts to improve. Your baby may need a lot of help from you during these early months. As long as you stay curious, you will be ready to take those small steps back when her reflux improves and she is ready to do more self-soothing. Your baby will eventually sleep well, even if her sleep is initially more challenging.