Working on sleep problems: Birth to 6 months
So far, we’ve looked at your baby’s normal sleep development, normal crying and how your baby communicates through non-verbal cues. It’s good to know what’s normal because it helps you decide whether or not you and your baby have any problems with sleep and settling.
You may have decided that your baby and you are perfectly normal and feel relieved to know that by setting up a routine and following along with your baby’s normal sleep development, everything will be fine. But if you’ve got to this point and decided that things aren’t quite right or your sleep routines may not be working in the way you thought they would, it’s time to figure out how to adjust the parts of sleep that aren’t working for you and your baby.
In this chapter, we will use Tresillian’s sleep and settling strategies as a guideline, with options to help you manage your baby’s sleep. Note that Tresillian does not recommend or use controlled crying for babies of any age.
Tresillian does not recommend or use controlled crying for babies of any age.
Birth to 3 months
As you know, for the first three months your baby’s sleep rhythms are still maturing, so she will sometimes require some gentle help settling to sleep and soothing back to sleep when she wakes between sleep cycles. This is perfectly normal during these early months.
It might be tempting to think that your baby has a sleeping problem during these first three months because she needs some help to relax off to sleep and keeps waking so frequently, but usually, it’s all part of your baby’s normal sleep development.
In the first month after birth, your baby will have a semi-regular, 2- to 4-hourly routine, around the 24-hour clock. Through the first month, 95 per cent of babies cry when they wake during a sleep and need a calm and gentle response before they can resettle and return to sleep.
From birth to 3 months, you are helping your baby establish her day–night rhythms and beginning to put in place a flexible feeding, socialising and sleep routine (see Chapter 1: How sleep works). During these months, bedtime routines, settling to sleep and resettling strategies will be simple and responsive to her needs.
Your baby may be quite sleepy for the first week or two after birth but, of course, she has her own personality and you may discover that she has quite different ideas! Some babies can be more wakeful than others, but this doesn’t mean there’s something wrong. These are just individual differences. You are finding out who she is and what she likes and doesn’t like. You are getting to know each other and that takes a little bit of time.
What your baby needs most at this stage is lots of cuddling, frequent feeds and a quick, soothing and sensitive response to her cries and distress.
People often say you will spoil your baby if you do that, but it’s not true. Once again, these beliefs emerged from the early-20th century ‘childcare experts’ who promoted the idea that babies should be pushed into independence from birth, and that responding to crying made a child whiney and spoilt.
The opposite is true: the more love and sensitive attention you provide your baby when she is distressed, the better she will be able to cope with distress later on.
Throughout the first month, focus on these aspects of caring for your new baby:
• Adjust to your new life with your baby.
• Begin to get to know your baby.
• Hold her close to you, especially when she’s distressed.
• Feed her when she’s hungry – this can be every 2 to 5 hours.
• Watch her carefully and get to know her non-verbal cues (see Chapter 6: How your baby communicates).
• Socialise and play with her when she is in a quiet, alert state (see Chapter 6: How your baby communicates).
• Settle her into her bed to sleep and gently and calmly help her back to sleep when she wakes after a sleep cycle.
By 3 weeks old, your baby will start to cry more as she moves into her normal developmental crying phase (see Chapter 5: Why your baby cries) and this may disrupt her sleep at some periods of the day, usually in the late afternoon or evening.
Routines. Once your baby is 2 to 3 months of age, her day–night rhythms have established and she’s more awake and sociable. You can probably begin to develop a more predictable yet flexible rhythm to your day during this time.
Your day will usually be organised around feeding, socialising and sleeping. A flexible rhythm may look something like this.
From birth to 3 months, help your baby establish her day–night rhythms and begin to put in place flexible routines.
Scenario: a flexible feeding and sleeping routine
Your baby wakes after a sleep of about 3½ hours. She shows you by her non-verbal cues that she’s hungry (see Chapter 6: How your baby communicates). You breastfeed her or give her a formula feed.
During the feed she falls asleep, so you decide to change her nappy and she wakes up again. She shows you by her non-verbal cues that she’s still hungry, so you give her some more milk. Finally, she shows you she’s full, alert and happy.
After her feed, her eyes are bright and shiny, she’s smiling at you and her arms are reaching for you. She’s ready to play and socialise. You both enjoy talking to each other for a few minutes before she starts to look away. You sit back and wait to see if she wants to talk and play again. She wants to keep socialising and this back-and-forth play and time out cycle continues for another 10 minutes. Finally, she becomes very fussy and she’s finished socialising.
You can see she looks drowsy. You check your watch and note she’s been awake for 1 hour and 15 minutes. You know she usually doesn’t last much longer than that. She’s showing non-verbal tired cues. You decide it’s time for bed.
You use responsive settling strategies to put her to sleep and when she wakes during her sleep, you use the same strategies to resettle her. This time she sleeps for 1½ hours and wakes up hungry. You can’t resettle her, so you feed her and she falls asleep again. You settle her and she returns to sleep.
You repeat this flexible rhythm throughout the day. At night, you don’t play or socialise with her.
In this scenario, you were able to wake your baby during the feed and she took some more milk from you because she was still hungry. If she falls asleep during a feed, it’s important to consider whether your baby might be hungry and want some more milk. Remember, though, that during these first few months your baby will often fall asleep immediately after a feed and this is quite normal.
It’s perfectly okay to leave her asleep if she falls asleep during the feed, and perhaps feed her more frequently if she wakes and seems hungry. You will have to look for her cues that tell you when she’s hungry.
The predictable thing about this flexible rhythm is that you:
• use the same settling strategies
• keep feed times in a flexible rhythm guided by her hunger cues
• use the same soothing strategies when she’s distressed (see Chapter 5: Why your baby cries)
• follow her cues (see Chapter 6: How your baby communicates)
• try to place her in the same place to sleep
• change her nappy before, in the middle or at the end of her feed
• have her bath time around the same time each day.
During these first three months, your baby may occasionally manage to soothe herself to sleep. You can try wrapping her firmly in a cotton wrap and putting her in her crib in a drowsy state, but she may still wake after a sleep cycle and require resettling.
Settling your baby in the early months
Settling your baby in the first three months isn’t complicated. She needs you to be patient while she matures and develops her normal sleep rhythms and cycles. This requires a sensitive and responsive approach to help her structure her day so that it’s calm, predictable and sociable, as well as gentle, soothing approaches to help her go to sleep and settle.
Remember that Tresillian doesn’t use controlled crying. Instead, the focus is on responding sensitively to your baby.
Young babies shouldn’t be left to cry inconsolably on their own. Crying is a call for comfort and help. A young baby will not ‘learn to sleep’ by being left to cry. A baby will just experience more distress if she doesn’t get the support and response she needs.
Once again, put yourself in your baby’s shoes. If you cry in bed prior to sleep, how do you feel? No one likes crying themselves to sleep, that’s exhausting and miserable.
If you try to put your baby to bed awake and she’s unable to settle on her own, leaving her to cry as a settling strategy is highly stressful for you both. The evidence suggests that she will just learn to stop crying rather than learn to sleep.
The strategies recommended by Tresillian encourage you to respond promptly and sensitively to your baby’s distress, her non-verbal cues and her states of consciousness, which are:
• wakefulness
• drowsiness
• active and quiet sleep.
Tresillian follows Red Nose recommendations on safe sleeping for your baby to reduce the risk of Sudden Unexpected Deaths in Infancy (SUDI), including SIDS.
Safe sleeping guidelines
• Sleep baby on the back from birth, not on tummy or side.
• Sleep baby with head and face uncovered.
• Keep baby smoke-free before birth and after.
• Provide a safe sleeping environment, night and day.
• Sleep baby in their own safe sleeping place in the same room as an adult caregiver for the first 6 to 12 months.
• Breastfeed baby.
Responsive Settling techniques
Tresillian uses a method to settle your baby called ‘Responsive Settling’. The following variously named techniques are suitable for your baby through each stage of her development: use the gentle soothing-in-arms technique for birth to 3 months; and then the hands-on settling technique (see page 153) for when your baby has established a predictable day–night routine, at around 3 to 6 months. (See Chapter 8 for information about Responsive Settling techniques for babies older than 6 months.)
Remember, Tresillian does not use controlled crying.
Responsive Settling: soothing-in-arms technique
Use the soothing-in-arms technique for the early weeks of your baby’s life, when she’s developing her day–night rhythms and doesn’t always have the ability to self-settle to sleep or back to sleep when she wakes. This is a gentle technique you can use from birth to 3 months, especially if you have a very unsettled baby.
Soothing-in-arms technique
1. Hold your baby in your arms until she falls asleep or becomes drowsy.
2. Use gentle, rhythmic patting, rocking, stroking, talking or soft singing before putting your baby into her cot when she is asleep or drowsy. These repetitions of soothing sounds and actions are comforting and signal relaxation and sleep.
3. If your baby wakes after a sleep cycle, you may need to re-settle her using any of the strategies listed in step 2.
These strategies help your baby settle and calm to sleep when she’s having trouble sleeping. These early months are the time when she needs the most help and reassurance from you.
By 3 months of age, your baby will probably have progressed through the normal developmental crying stage and her crying is reduced to about 1 hour per day. Her sleep rhythms will have matured and she will be shifting into a new phase of development.
These early months are the time when she needs the most help and reassurance from you.
3 to 6 months
At 3 months of age, your baby has a major developmental growth spurt. Her body is much more under her own control and her little hands are becoming useful at last. She enjoys looking at her hands and will start to use them.
You will notice she spends more time awake and she is much more sociable and interested in interacting with you. She loves to gaze at you.
If you watch her carefully, she will gaze at you, move her body and vocalise almost in time with you when you gaze at her, speak, smile and play. While she’s doing this with you, she’s developing her thinking skills, and her social and emotional development is evolving.
At about 4 months, she’ll begin to shift her gaze from you and look at toys when you show them to her. She will become more interested in toys as she moves towards 6 months.
Her wakeful periods will last from 1½ hours to as long as 2½ hours, and her daytime naps will be approximately 2 hours long. These lengths of time are averages only and they will match her age and development. For example, your 3-month-old baby will have longer and more frequent naps than a 6-month-old baby, and she will have shorter wakeful periods than a 6-month-old baby.
Daily routine
Once your baby gets to 3 months she is more awake and alert, so her routines begin to have a more predictable pattern. But her routines remain flexible and you need to adapt them to her age and development.
Sample routine for your 3-month-old baby
• Wake at 5 am, have an early milk feed and start the day, or return to sleep
• Have a milk feed every 3 to 4 hours
• Play and socialise with you after a milk feed
• Perhaps have some floor play on her own or sit watching you while you do something
• Go for a walk in the pram or visit friends
• Carefully watch your baby for when she gets drowsy and use your tired sign formula (see page 125). Remember, it’s best to put her to bed when she’s in a drowsy state.
• Have a 2-hour sleep
• Have a bath and her bedtime routine in the evening and settle for the night
• One to two milk feeds overnight, usually at about 10 pm or 11 pm and another at 1 am or 2 am.
By 6 months of age, her meals and bedtime routines will be beginning to look a little like the rest of the family’s. Your 4- to 6-month-old baby’s routine may look like this:
Sample routine for your 4- to 6-month-old baby
• Wake at 5 am and start the day after her early morning milk feed, or maybe return to sleep
• Morning tea milk feed (at 6 months, you may have started her on solids)
• Playtime includes social time with you enjoying toys together, singing songs, reading books, floor play on her own or sitting in her highchair watching you while you prepare your lunch and do some chores
• Go for a walk in the pram, visit friends, baby playgroup
• Carefully watch your baby for when she gets drowsy and use your tired sign formula (see page 125). Remember, it’s best to put her to bed when she’s in a drowsy state.
• Lunch milk feed (at 6 months, you may have started her on solid food)
• Have a 2-hour sleep twice a day
• Afternoon milk feed
• Have a bath and her bedtime routine in the evening and settle for the night
• Evening milk feed
• She may still want a milk feed overnight, usually at about 10 pm to 11 pm or at about 1 am to 2 am.
Disruptions. Routines don’t always go smoothly and are easily disrupted by changes in the family environment, illness and going on holidays (see Chapter 4: Creating a conducive sleep environment). Disruptions also occur to your routine when you have busy days out and about. For example, shopping centres are highly stimulating with lots of people, noise and bright lights.
It’s hard for your baby to sleep under such circumstances. Again, put yourself in your baby’s position and imagine what it would be like to try and sleep in a busy shopping centre when your sleep is still developing. Too much stimulation will disrupt her routine. Small amounts are fine.
Sleep difficulties. It’s thought that about 60 to 70 per cent of 4-month-old babies will be able to sleep continuously for episodes of about 5 hours a night on most nights of the week and wake two to three times during these episodes (see Chapter 2: Sleeping longer through the night). These babies are able to settle themselves back to sleep after an awakening, but about 30 per cent of babies cry out when they wake.
It’s during this period of your baby’s life that you and she may find yourselves falling into some sleep habits that may contribute to sleep difficulties later on. The real issue about sleep difficulties is not that your baby wakes up at night or during her daytime naps, because that’s normal, but working out why she calls out when she wakes. The ability to stop calling to you when she wakes is believed to be a normal sleep maturational process that will develop over time.
By 3 to 4 months, about 70 per cent of babies will have reduced the number of times they call out to about once per night, on most nights of the week. If your baby keeps calling out to you many more times than this, it’s because she’s still developing the capacity to settle on her own. She may still need some gentle and responsive help from you.
There are two types of well-recognised sleep problems that occur over the next few months. The first is that your baby has difficulties going to bed and falling asleep on her own. And the second is your baby can’t return to sleep on her own after waking between sleep cycles.
There are lots of different reasons why sleep problems occur, but one thing is for sure: it’s always a combination of reasons that involve both you and your baby (see Chapter 3: The two sides of your sleep problems).
After your baby is about 3 months old, one of the most important things you can do is to help her start to soothe herself to sleep at the beginning of each sleep.
Going to bed awake
Once the first three months have passed and your baby has settled into a more regular day–night rhythm, she is developing a greater capacity to soothe herself to sleep at bedtime and when she wakes during the night and her naps. You can support her sleep development by using some simple settling strategies.
Calming bedtime routine
• Carefully watch for when your baby gets drowsy and use your tired sign formula (see page 125). Remember, it’s best to put her to bed when she’s drowsy.
• Wrap her firmly but comfortably in a cotton wrap, with her arms flexed against her chest so she can get her hands to her mouth in case she wants to suck them. This will help her to soothe herself. Leave enough room in her wrap for her to move her legs. You don’t want to wrap her tightly like an Egyptian mummy. You can imagine it would be an unnatural and uncomfortable way to sleep, with your arms pinned straight down your sides.
• Speak to her in a calm, soothing and low voice while you’re getting her ready for bed and putting her into her crib. Sing a lullaby if you enjoy singing.
• Put her to bed in the same familiar place.
• If it’s daytime, you don’t need to make the room totally dark. A little daylight is fine.
• If it’s night-time, ensure the light in the room isn’t stimulating, such as light from the TV, computers, smartphones or tablets (see Chapter 1: How sleep works).
• Give her a reassuring kiss or stroke her head and leave her to see if she can settle.
Firstly, to address any potential future difficulties with her going to bed, you can start by putting your baby to bed awake. This is a good time to begin with a simple, soothing and calm bedtime routine.
While she is trying to settle herself, she will make lots of little noises, like grunts and snorts, sometimes a louder squeak. It’s okay to leave her alone while she does that, as she is probably transitioning from a drowsy state to another sleep state (see Chapter 2).
It’s important not to interrupt her during that process. So, unless she starts to fuss and cry loudly, just leave her alone to give her the opportunity to go to sleep by herself. If you can manage to hold back and allow her to have a good try, this will help her to start to develop a really good sleep routine.
For example, if you take a peep at her as she moves from a drowsy state to an active sleep state, she may still seem awake to you because her eyelids may be fluttering, her breathing may be irregular and she may be moving and twitching. It’s best to leave her alone at this stage so she can move from active sleep into a quiet, deeper sleep state.
If your baby doesn’t manage to fall asleep on her own when you put her to bed awake, this may be because she is still developmentally immature. The capacity to settle on her own to sleep and during sleep develops over time, and each baby is different. Even so, from around the third month of your baby’s life it’s worthwhile to give her the opportunity to go to bed awake and settle on her own.
Waking between sleep cycles
The second sleep problem that may occur over the next few months is that your baby may find soothing herself back to sleep after waking between sleep cycles quite difficult.
Once your baby is 3 to 6 months old and she is developing the ability to soothe herself to sleep, she also has the ability to sleep for 2 to 3 hours at a stretch during the day and 5 hours at night. During these prolonged stretches, she may manage to soothe herself back to sleep between sleep cycles at least once. When you put her to bed awake and give her the opportunity to soothe herself to sleep, this may help her to soothe herself when she wakes between sleep cycles. But even at this young age, your baby won’t be able to do this at every sleep; or she may not be able to do it at all.
There is some debate about why some babies aren’t able to soothe themselves to sleep. These are the two possible reasons:
1. Some babies’ sleep development is more immature than other babies’. They need more help to fall asleep and also to go back to sleep when they wake between sleep cycles.
2. Other babies’ sleep development may be maturing normally, but their parents might not be giving them the space they need to practice settling themselves to sleep. Some parents respond too quickly when their baby wakes during the night.
Both these reasons are very common, and neither you nor your baby is to blame. This is a bit like the chicken or the egg scenario.
If your baby’s sleep development is a little immature, then of course you’re going to attend to her and try to put her to sleep. What can then happen is your baby can begin to associate your presence and your method of putting her to sleep with going to sleep.
Or you might mistake the little noises she makes when she wakes as calls for help, and you go to her too quickly. Once again, she begins to associate needing you to be with her in order for her to go back to sleep.
These are called ‘sleep associations’, which basically means that whatever you do to put your baby to sleep – such as feed her or hold her until she’s asleep and then put her into her bed when she’s asleep – she will expect the same from you each time she wakes up, even throughout the night.
The best way to manage sleep at this age is to continue with the same calm, soothing and responsive strategies you used during the first three months but add in a little more structure to help her settle.
Responsive Settling: hands-on settling technique
Once your baby has established a predictable day–night rhythm and you can see she has a beginning capacity to self-settle, from between 3 to 6 months, start incorporating the hands-on settling technique in your routine.
Wrap your baby with her arms up on her chest so she can move them to her mouth if she needs to; or use a sleeping bag with fitted armholes, and no hood (following Red Nose safe baby sleeping bag guidelines).
Hands-on settling technique
1. Talk quietly and cuddle your baby to help her calm.
2. Place your baby in her bed when she is in a calm and drowsy state but still awake.
3. Comfort your baby with gentle ‘shhh’ sounds and gentle rhythmic patting, rocking or stroking until she is calm or asleep.
4. If your baby becomes or stays distressed, pick her up for a cuddle until she’s calm or asleep before putting her back in her bed.
5. Stay with your baby until she is asleep.
During her first six months, your baby is developing rapidly in all areas: physically, emotionally, mentally and socially. Just like walking and talking, sleep is one of those areas of development that matures over time. You wouldn’t expect your baby to begin walking or talking to you at 3 months, and sleep is just the same. It takes quite a long time before your baby will sleep through the night, and just like walking and talking, it takes some baby’s longer than others to develop the capacity to sleep longer and self-settle. Some parents like guidelines to support their baby’s sleep development, especially when sleep seems to be a problem for both them and their baby.
As this chapter outlined, there is quite a steady development in your baby’s ability to settle to sleep and self-settle back to sleep during the first six months. She starts off after birth with very little capacity to settle herself and needs lots of help. By 3 months of age, she’s beginning to put herself to sleep and settle herself during the night, and that’s when you might start to get some longer sleeps. With your loving help and support, and using the Tresillian Responsive Settling techniques, by 6 months she may be able to go to bed and fall asleep, then self-settle on her own during the night (see Chapter 2: Sleeping longer through the night for length of sleep times).
Jillian’s story (mother of Luca, 11 months)
If I’m honest, the sleep issues with my son were mainly to do with my husband and me. My son would wake after 40 minutes during the day and every 2 hours at night. During the day, I would just assume that he’d had enough sleep after 40 minutes and would get him up.
As time went on, he was crying more and more and sleeping even less. I was completely exhausted and when Luca was around 4 months old, I realised I needed to get help. I spoke to my GP and booked a Day Stay at Tresillian.
My husband and I are against controlled crying – we wanted to ensure we weren’t abandoning him, so we responded to his every cry. What we didn’t realise was that often babies need to make noises to go to sleep. We were actually overdoing trying to settle him for every sleep and were disturbing his ability to learn how to settle himself.
At Tresillian, the nurse sat with us while our son tried to self-settle. She helped us distinguish his noises and showed us which ones were him just settling himself and which ones were actual distress and required our input.
For the first nap, we sat outside the door for a few minutes while he grizzled (although it felt like years). After 5 minutes, he really started to get upset, so she told us to go in and comfort him. She said, ‘Don’t pick him up. Be calm, go in slowly, put your hand on him and shush/pat him. If he’s unwrapped, then wrap him back up, but don’t make a big production out of it.’
So, we did all that and waited until he was calm, then we went out again. We had to keep going in and out for about half an hour but eventually, he went to sleep.
‘And that’s how you do it,’ the nurse said. It was a definite eye-opener.
When we got home, we kept practising and after a few weeks he worked it out and he started settling himself to sleep. I also had to help resettle him between naps as he would wake after 40 minutes but, after a while, he learned how to transition between sleep cycles and I wouldn’t hear a peep. The first day he did a 90-minute nap, I didn’t know myself!
These days, he’s doing two good naps a day and even though he still wakes every so often overnight, we’re all getting reasonable sleep. Although it was hard to hear, I’m glad that I found out early that I wasn’t doing it right and how to fix it.
Key message
• For the first three months, your baby’s sleep rhythms are still maturing, so she will sometimes require some gentle help settling to sleep and soothing back to sleep when she wakes between sleep cycles.
• At 3 months of age, your baby is much more sociable and loves to interact with you. She is much more awake and alert during the day and her feeding, socialising and sleeping routines begin to have a more predictable pattern. At this age, she may stay awake for 1 to 2 hours at a time and have 2-hour naps.
• Between 3 and 6 months, your baby will develop a predictable day–night rhythm and have the beginning capacity to self-settle.
• By the time your baby reaches 6 months, her awake periods will be longer, but she will still have two to three naps of varying lengths during the day. At 6 months, many babies have the ability to sleep for a 6-hour stretch at least once at night. Your baby may have started solids and have a solid breakfast with you in the morning, she may have lunch, snacks and dinner, and she will have an evening bedtime with a routine.
