5

Establishing the Contented Little Baby Routines

The times for feeding and sleeping change 10 times during the first year of the CLB routines to ensure that the individual needs of every baby can be properly met. It is very important that you carefully read the advice and information in the feeding and sleeping chapters before you even attempt to start the routines. They will help you understand how best to use the routines so that your baby is happy, content, and eating and sleeping well.

After the birth follow the advice given for a newborn until he has regained his birth weight and shows signs of being able to go longer between feedings. Then you can move on to the first routine. Gradually, when your baby shows signs of going longer between feedings and staying awake longer, you can move on to the next routine. Do not worry if your baby is not managing the routine for his age; just stick to the routine that he is happy in and continue to watch for the signs that he is content and able to go longer between feedings and stay awake longer. Then move on to the next routine.

If you are starting the routines with an older baby who has established a pattern of demand-feeding and sleeping, look through the routines and find the one nearest to the pattern he is in now. Follow that routine for a short period and then, once he is eating and feeding happily at the times in that routine, you can move on to the next routine, gradually working your way through the different routines until he eventually reaches the one suitable for his age.

Feeding

Small babies spend a great deal of their waking time eating. To avoid excessive night feeding, it is important to structure and establish a good daytime pattern. As I have explained, in order to establish a good milk supply I believe that your baby needs to be fed little and often. The success of the CLB routines depends upon the baby being woken for feedings and not being left for long spells in between feedings. I recommend that in the very early days an every three-hours-feeding routine be established. This time is calculated from the beginning of one feeding to the beginning of the next. Of course, if a baby is demanding milk before the recommended time, I have always advised that he should be fed. But if this continues long after the milk has come in, then it is important to look for reasons why your baby is not lasting longer between feedings.

Only once a baby has regained his birth weight and continues to have a steady weight gain, do I recommend that the times between feedings should be extended and only if the baby shows signs of happily going longer between feedings. By structuring your baby’s feedings from early on, things should never get to a stage at which he is having to cry to let you know he is hungry, as you will already be preempting his feeding needs.

From the very beginning, it is important to differentiate between feeding, sleeping and social times. If you talk too much or overstimulate him while feeding, he could lose interest after a couple of ounces, and then may not settle well into sleep. This could result in you feeding him to sleep, which in the long term can create sleep problems. Also avoid talking on the telephone for long periods while feeding.

It is important during the very early days that you concentrate on the positioning of your baby on the breast to ensure that he feeds well. Do seek help from a lactation consultant to make sure that you are getting the feeding position right. If you nurse him in a rocking chair, do not be tempted to rock him while feeding, as he will think it is sleep time, and if he is sleepy while feeding, he will not eat so well and will need to nurse again sooner. Sleepy babies are also often more prone to spitting up.

The aim of the CLB feeding routines is to ensure that when your baby is ready to increase the amount of milk he drinks, you structure his daytime feedings to correspond with his daytime sleep. This will mean that, as soon as your baby is physically and mentally capable, he will sleep his longest spell in the night and not during the day.

Sleeping

It is essential for your baby’s mental and physical development that he gets enough sleep; without the right amount, he will become irritable, fretful and inconsolable. A baby who is constantly tired will not eat effectively and, therefore, not sleep properly. As I have already mentioned, one of the most important things that you should remember in the early days is that very young babies can only stay awake for up to two hours before becoming tired. If your baby stays awake for longer than two hours he could become so exhausted that he will need a much longer sleep at his next nap time. This will have a domino effect, altering the rest of his routine, resulting in poor evening and nighttime sleep. Therefore, it is essential that you structure the awake period properly, so that the feeding and sleeping plan works well. In the early days, some babies can only stay awake for an hour after eating; this is fairly normal for babies who need more sleep.

To determine whether your baby is a sleepy baby or not, consider his nighttime sleep pattern. If he can stay awake for only an hour at a time during the day but settles well in the evening and eats and settles quickly during the night, then he is a baby who needs more sleep. He will eventually manage to stay awake for longer amounts of time, provided you ensure that he is given the opportunity. You can do this by trying whenever possible to settle him in a quiet room for naps and having him in a bright, social and noisier environment during his waking time. Create the contrast between nap and social time to help him learn when it’s time to sleep and when it’s time to play.

However, if he can stay awake for only an hour at a time during the day but for several hours during the night, it is possible that he has his day and night confused, and it is worthwhile encouraging him to stay awake more during the day. Babies learn by association. It is very important that from day one he learns the right associations and to differentiate between eating, playing, cuddling and sleeping.

You will also find that there are some times of the day when your baby will stay awake for two hours quite happily and other times when he will be tired after an hour. This is perfectly normal in the early days, which is why I say that babies can stay awake for up to two hours—not that they must stay awake for two hours.

Along with the routines, the following guidelines will help your baby develop healthy sleeping habits:

Keep him awake for a short spell after his day feedings.

Do not let him sleep too long in the late afternoon.

Do not feed him after 3:15 p.m., as it will throw off his next feeding.

Follow the same routine every evening; do not allow visitors around the baby during wind-down time.

Do not let him get overtired; allow at least one hour for the bath, feeding and winding-down time.

Do not overstimulate him or play with him after his bath.

Do not rock him to sleep in your arms; settle him in his crib before he goes into a deep sleep.

If you use a pacifier to calm him down, remove it before you put him in his crib.

If he falls asleep on the breast or bottle, arouse him slightly before settling him in his crib.

Playing

All babies love to be cuddled and talked and sung to. Research also shows that even very small babies like to look at simple books and interesting toys. For your baby to enjoy these things, it is important that you do them at the right time. The best time is usually approximately one hour after he is awake and has been fed. He should never be played with or overstimulated 20 minutes before his nap. Imagine how you would feel if you were just drifting off to sleep and someone came into the room and wanted to laugh and joke with you. I doubt you would be too happy about it, so respect that your baby needs the same quiet time before he goes off to sleep.

Pay particular attention to what toys your baby gets used to in his crib. I find it a great help to divide toys and books into wake-up and winding-down ones. Musical crib mobiles and colorful baby gyms, plus black-and-white cloth crib books are all excellent for keeping young babies interested for short spells, during social time, as are postcards and posters that show single objects or faces. Use these toys only during social times and two or three different, less stimulating toys for winding-down times.

Babies have very short concentration spans; constantly talking and handling a baby during the social time can often result in him becoming overstimulated. It’s important to take the cue from your baby as to how much stimulation he can handle. Even from a very young age, babies should be encouraged to occupy themselves for short periods and have freedom to move. This is much more likely to happen if the baby is allowed to lie on his play mat or under his crib mobile, as he will be able to kick and move around more than when he is being held.

Cuddling

Babies need lots of cuddling, but it should always be done when your baby needs it, not when you need it. A baby needs energy to grow, so it is important that you do not overhandle his small body and exhaust him. While all babies need to be nurtured, they are not toys. Differentiate the type of cuddle during his playtime from that of winding-down time. Winding-down cuddling should be about closeness of bodies. It is important that your baby is not cuddled to sleep while feeding. After one hour of being awake and fed he should be happy to spend a little time amusing himself; if you constantly cuddle him during playtime, he will be less likely to respond to the cuddles that would normally help settle him for his nap. When cuddling him during the winding-down time, do not talk and avoid eye contact, as it can overstimulate him and result in him becoming overtired and not settling. Instead, just enjoy that peaceful connection and closeness that you feel with him.

Structuring the Milk Feedings During the First Year

During the first few weeks, regardless of whether babies are breast- or formula-fed, very few can manage a strict every-four- hour-feeding pattern, and the aim of the CLB feeding routines is to ensure that the individual needs of all babies can be met. That is why I recommend that babies are fed every three hours in the early days, and only when they have regained their birth weight and are gaining weight steadily should they be left to go longer for feedings. By two weeks, if your baby has regained his birth weight and weighs more than 7 lbs., he should manage to last 3–4 hours between some feedings, provided he is drinking the full amount at the times stated in the routines. By structuring feedings in the early days, you can achieve several slots of every-three-hours feedings and some of a four-hour stretch. If you structure his feedings according to the routines, the four-hour stretch between feedings should always happen between 10 a.m. and 2 p.m. and 7 p.m. and 7 a.m. This would mean that a baby who ate at 6 p.m. should get to 10 p.m., and then eat again around 2–3 a.m., then again at 5/6–7 a.m.

The three-hour stretch between feedings is timed from the beginning of one feeding to the beginning of the next; a baby starting to feed at 7 a.m. would then need to start his next feeding at 10 a.m. However, if you feel your baby is genuinely hungry before his next feeding is due, as I have mentioned earlier, he must be fed—but it is also advisable to get to the root of the problem as to why he is not taking a full feeding at the times stated in the routines. If you are nursing, it may be that he needs longer on the second breast; if you are bottle-feeding, it may be that he needs an extra ounce at some feedings.

Between the second and fourth week, most babies who are gaining weight steadily are able to last slightly longer after one feeding—usually 4¹⁄₂–5 hours. If you structure your baby’s feedings, this will automatically be at the right time, i.e., between 11 p.m. and 7 a.m.

If your baby has been demand-fed and you are attempting to put him into a routine, I advise that you look at the early routines and put him into a routine that seems nearest to his demand-fed pattern. For example, a nine-week-old baby may need to start on the 2–4 week schedule. When he is happy in that routine, you should be able to work your way through the next two sets of routines within 7–10 days. By the time he reaches 12 weeks, he should be happily eating at the times stated in the routine for his age. However, although it may take slightly longer for him to sleep through the night, the important thing is that he is only feeding once in the night and gradually increasing the length of time he sleeps from his last feeding, over a period of several weeks. Once the baby starts to sleep longer in the night, it is important to keep a close eye on how you structure feedings, as things can go wrong, particularly if you have been too strict. Remember the whole key to the CLB feeding routines is that they are flexible and that no baby should ever be forced to go longer before feeding than he is physically capable of.

The following extract is from the diary of a mother with a five-week-old baby going approximately four hours between feedings. It shows how quickly things can go wrong, when a strict routine of feeding every four hours is followed.

Aware that her baby’s eating pattern was going haywire, the mother tried to get it back on track on the Friday night by waking the baby up at 11 p.m. This did not work, as the baby had taken a full feeding at 9 p.m. and was not hungry. The results were so poor that the baby woke up at 2 a.m. needing a full feeding, which meant a total backtrack on night feeding. Even if the mother had managed to settle the baby at 9 p.m. with a smaller feeding, it is unlikely the baby would have eaten any better. The baby had only been asleep for one hour so it would have been very difficult to wake him up enough to nurse properly.

As I mentioned earlier, the easiest way to keep your baby on track is to wake him at 7 a.m. Once he is sleeping to 5 a.m. or 6 a.m., he should be offered a top-up feeding at 7 a.m. or 7:30 a.m. This method will not only keep the rest of your feedings on track, but also ensure that your baby’s sleeping is kept on track and that he is ready to go to bed at 7 p.m.

The following advice will also ensure that your baby sleeps through the night as soon as he is physically able, and prepare him for the introduction of solids and the eventual reduction of milk feedings.

Understanding the Routines for Feeding

The 6–7 A.M. Feeding

Depending upon what time he ate during the night, your baby will probably wake between 6 a.m. and 7 a.m., but he should always be woken at 7 a.m. regardless. Remember that one of the main keys to getting your baby to sleep through the night is to ensure that once he is physically capable of taking bigger amounts, he gets his daily requirements between 7 a.m. and 11 p.m.

Regardless of whether he is breast- or bottle-fed, the only way to keep a baby in a good routine is to begin the day at 7 a.m. Once he is sleeping through the night, he should be at his hungriest at this feeding.

During growth spurts, breast-fed babies should be given longer on the breast to ensure that their increased needs are met. If you have been expressing, you can increase this by 1 oz. If you have not been expressing, you can still follow the feeding times from the routine for your baby’s age; just top him up with a short breast-feed before his daytime naps. If you do this for a week or so, this should help increase your milk supply. A sign that this has happened is that your baby will sleep well during his naps and not be so interested in the next feeding.

BY SEVEN MONTHS

If your baby is eating a full breakfast of cereal, fruit and perhaps small pieces of toast, you should aim to cut back the amount offered to him from the breast or bottle. Divide the milk between the drink and the cereal. Always encourage him to take at least 5–6 oz. before he is given his solids.

If you are still nursing, gradually reduce the time he is on the first breast, then give him his solids and, finally, a further short feeding from the second breast. Keep a very close watch that you do not allow him to increase his solids so much that he cuts back too much on his breast-feeding.

Your baby still needs a minimum of 20 oz. a day, inclusive of milk used in cooking or on cereal, divided between 3 or 4 milk feedings.

BY TEN MONTHS

If your baby is formula-fed, encourage him to drink all his milk from a cup. Ensure that you still offer milk at the start of the meal. Once he has taken 5–6 oz. of his milk, offer him some cereal. Then offer him the remainder of his milk again.

It is important that he has at least 6–8 oz. of milk divided between the cup and the breakfast cereal.

If you are still nursing, offer him first the breast then the solids, then offer him the breast again.

Your baby needs a minimum of 18 oz. a day, inclusive of milk used in cooking or on cereal, divided between 2 or 3 milk feedings.

The 10–11 A.M. Feeding

During the first few weeks, the majority of babies who have eaten between 6 a.m. and 7 a.m. will wake looking for a feeding around 10 a.m. Even if your baby does not do this, it is important that you wake him. Remember that the aim is to ensure that your baby feeds regularly during the day so that he only needs to wake once for a feeding between 11 p.m. and 6–7 a.m.

In the early days, many babies would happily sleep 4–5 hours between feedings during the day. Regardless of whether a baby is breast-fed or bottle-fed, within a very short period, this usually leads to several nighttime feedings as the baby attempts to get all his daily nutritional needs. It also puts him at possible risk of dehydration.

Too few feedings during the day in the early weeks also does little to help establish a good milk supply for a breast-feeding mother, and nursing several times a night soon exhausts the mother so much that her milk supply is reduced even further.

Around six weeks, your baby may show signs of being happy to go longer from the 7 a.m. feeding, and the 10 a.m. feeding can gradually be pushed to 10:30 a.m. However, a baby who is eating at 5 a.m. or 6 a.m. and being topped up at 7:30 a.m. would probably still need to eat at 10 a.m., as would the baby who has too little to eat at 7 a.m.

Once he is sleeping through the night, or taking only a small feeding in the night, he should have the biggest feeding of the day at 6:45–7 a.m. If he eats well, he should be happy to last until 11 a.m. before needing to eat again. However, if you feed him before he really needs it, he may not eat well and, as a result, may sleep poorly at the lunchtime nap. This will have a domino effect so that each subsequent feeding and nap has to be given earlier, and may result in the baby waking at 6 a.m. or earlier the following morning.

This feeding would be the next one to be increased during growth spurts.

BY 6–7 MONTHS

When your baby is eating breakfast, you can start to make this feeding later, eventually settling somewhere between 11:30 a.m. and noon. This will be the pattern for three meals a day at the end of six months, at which stage the milk feeding will be replaced with a drink of well-diluted juice or water from a cup.

It is important that you introduce the tier system of feeding so that he gradually cuts back on the amount of milk he drinks and increases his intake of solids.

Some babies simply refuse to cut back on their milk intake at this feeding. If you find that your baby is one, please refer to Chapter Sixteen, Problem Solving in the First Year, for suggestions.

BY SEVEN MONTHS

Once your baby is on a fully balanced diet of solids, which includes protein with lunch, it is important that this feeding be replaced with a drink of water or well-diluted juice. Formula given with a protein meal can reduce the iron absorption by up to 50 percent.

Give the baby most of his solids before his drink so he doesn’t fill up with liquid first.

THE 2:30 P.M. FEEDING

During the first few months, make this feeding smaller so that your baby eats really well at the 5–6:15 p.m. feeding, the exception being that if your baby doesn’t sleep well at lunchtime, he will need to eat earlier with a top-up at 2:30 p.m. If, for some reason, the baby eats poorly at the 10 a.m. feeding or was fed earlier, increase this feeding accordingly so that he maintains his daily milk quota.

If your baby is very hungry and regularly drains the bottle at this feeding, then you can give him the full amount, provided he does not take less at the next feeding.

For breast-fed babies, allow longer on the breast if he is not managing to get happily to the next feeding.

BY EIGHT MONTHS

When your baby is having three full solid meals a day and his lunchtime milk feeding has been replaced with water or well-diluted juice, you will probably need to increase this feeding so that he is getting his daily milk quota in three milk feedings.

However, if he cuts back on the last milk feeding of the day, it would be advisable to keep this milk feeding smaller and make the daily quota by using milk in cereals and cooking.

Your baby still needs a minimum of 18–20 oz. a day, inclusive of milk used in cooking and on cereal.

BY 9–12 MONTHS

Bottle-fed babies should be given their milk from a cup at this stage, which should automatically result in a decrease in the amount they drink.

If this is not the case and your baby starts to lose interest in his morning or evening feeding, you could cut back on this feeding. If he is getting 18–20 oz. of milk a day (inclusive of milk used in cooking and on cereal), plus a well-balanced diet of solids, you could cut this feeding altogether.

By one-year-old, your baby needs a minimum of 12 oz. a day, inclusive of milk used in cooking and cereal.

The 6–7 P.M. Feeding

It is important that your baby always has a good feeding at this time if you want him to settle down well between 7 p.m. and 10 p.m.

He should not be fed milk after 3:15 p.m., as it could put him off taking a good feeding later in the evening.

In the first few weeks, this feeding is split between 5 p.m. and 6:15 p.m. so that the baby does not get too frantic during his bath. Once your baby has slept through the night for two weeks, the 5 p.m. feeding can be dropped. I would not recommend dropping the split feeding until this happens, as a larger feeding at 6:15 p.m. could result in your baby taking even less at the last feeding, resulting in an earlier waking time. With many of the babies that I cared for, I continued to give them a split feeding until solids were introduced to ensure that they were getting enough milk during the day. Once you eliminate the 5 p.m. feeding and your baby is taking a full feeding after the bath, he could cut down dramatically on his last feeding of the day, which could result in an early waking.

Breast-fed babies not settling at 7 p.m. should be offered a top-up of expressed milk. Your milk supply may well be low at this time of the day.

BY 4–5 MONTHS

If your baby has started solids early, he should be given most of his milk before his solids, as milk is still the most important form of nutrition at this age.

Most babies will be taking a full breast or bottle-feeding at this age.

If he is weaned and very tired when he eats, and you are struggling to get him to drink all of his milk plus any solids you have been advised to introduce, adjust the feeding times. Try giving two-thirds of each milk feeding at around 5:30 p.m. followed by his solids, then delay his bath until around 6:25 p.m. After the bath he can then be offered the remainder of his milk feeding. If formula feeding, it is advisable to make two separate bottles to ensure that the milk is fresh.

A breast-fed baby who has reached five months, is being weaned and is now starting to wake before 10:30 p.m. may not be getting enough milk at this time. Try giving a full breast-feed at 5:30 p.m. followed by the solids, with a bath at 6:15 p.m., followed by a top-up of expressed milk or formula after the bath. A baby who is not weaned would more than likely need to continue to have a split-milk feeding at 5–6:15 p.m. until solids are introduced.

BY 6–7 MONTHS

Most babies will now be having supper at 5 p.m. followed by a full breast-feed or a full formula-feed. Once solids are established and the late feeding is dropped, you may find that if you are breast-feeding, your baby starts to wake earlier. I suggest that if this happens you offer a top-up of expressed milk to ensure that he settles well at 7 p.m. and sleeps until morning.

BY 10–12 MONTHS

Bottle-fed babies should be taking all of their milk from a cup at one year. Babies who continue to feed from a bottle after this age are more prone to feeding problems, as they continue to take large amounts, which takes the edge off their appetite for solids.

Start encouraging your baby to take some of his milk from a cup at 10 months, so that by one year he is happy to take all of his last feeding from a cup.

The Late Feeding

I strongly advise that parents of breast-fed babies should introduce bottles of either expressed milk or formula at this feeding and do it no later than the second week. This will help the primary caregiver share the feeding responsibilities with a partner.

This also helps to avoid the common problem of a baby refusing to take a bottle at a later stage.

A totally breast-fed baby less than three months who continues to wake between 2–3 a.m. and shows no sign of going for a longer stretch in the night may not be getting enough to eat at this time, as the breast-milk supply is often at its lowest at this time of day.

If you choose to top-up with expressed milk or formula rather than completely replacing the feeding with a full bottle-feeding, it is essential to make sure your baby has completely emptied the breast before he is offered the top-up feed.

It is easier to tell whether formula-fed babies are getting enough to eat at this feeding. If you always increase the day feedings during your baby’s growth spurts, he will probably never require more than 6 oz. at this feeding. However, babies who weighed more than 10 lbs. at birth may reach a stage at which they need more than this—at least until they are well established on solids.

Refer to Chapter Three, Milk Feeding in the First Year, for calculating how much formula your baby needs each day, and for how to structure the feedings.

BY 3–4 MONTHS

If your baby has slept through the night until 7 a.m. for at least two weeks, then you can bring this feeding forward by 10 minutes every three nights, until your baby is sleeping from 10 p.m. to 6:45–7 a.m.

If your baby is totally breast-fed and is still waking early in the night, despite being topped up with expressed milk at the late feeding, it may be worthwhile talking to your doctor about replacing the late breast-feeding with a formula-feeding. Most formula-fed babies will be taking 7–8 oz. a feeding 4–5 times a day.

If a formula-fed baby is not sleeping through the night at this age, it may be because he needs a little extra at this feeding, and even if it means he cuts back on what he eats in the morning, it may be worth offering him an extra ounce or two.

Some babies simply refuse this feeding at 3–4 months. If your baby is eating well from the breast four times a day and your doctor is happy with his weight gain, you can just drop this feeding. However, if you find that he starts to wake earlier again and will not settle back to sleep within 10 minutes or so, assume it might be hunger and feed him. You may then have to consider reintroducing the late feeding until he is weaned and established on solids.

If your baby is waking twice in the night (i.e., 2 a.m. and 5 a.m.) or is not sleeping past 5 a.m., you can try waking the baby at 9:45 p.m. for this feeding. Ensure he is wide awake either by changing his diaper or by letting him play for a few minutes on his mat. Turn on all the lights. He should be ready to eat by 10 p.m. Feed him, then keep him up until 11 p.m. by changing him or playing (whichever you didn’t do at 9:45 p.m.). Top him up just before he goes down at 11 p.m. By ensuring he is awake for longer at this feeding and splitting it, he should wake only once in the night. Once this is established and he is going for a longer spell at night, you can slowly move the whole of this feeding back to 10 or 10:15 p.m.

BY 4–7 MONTHS

The majority of babies at this age should be capable of sleeping through the night from their last feeding, provided they are having their daily intake of milk between 7 a.m. and 11 p.m.

A baby who is being exclusively breast-fed may only manage to get through to around 5 a.m. until he is weaned.

Once your baby has been weaned and is established on three solid meals a day, this last feeding should gradually reduce automatically. This will depend upon how much solid food your baby is taking once he reaches 6–7 months. If you have been advised to wean your baby earlier than six months, you should find that you could drop this feeding fairly quickly once he reaches this age. A baby who did not start solids until the recommended age of six months may still need this feeding until he reaches seven months. By this time, provided the baby is taking enough milk and solids during the day, you should be able to gradually reduce the amount he takes and then eliminate it altogether.

THE 2–3 A.M. FEEDING

Newborn babies need to feed little and often during the first week, so when they wake it is best to assume that they are hungry and feed them.

A newborn baby should never be allowed to go longer than three hours between feedings during the day and four hours between feedings in the night. This time is measured from the beginning of one feeding to the beginning of the next.

Once your baby has regained his birth weight, he should start to settle into the two- to four-week routine. Provided he eats well between 10 p.m. and 11 p.m., he should manage to sleep closer to 2 a.m.

BY 4–6 WEEKS

Most babies gaining the right amount of weight each week are capable of lasting a longer stretch between feedings during the night, as long as

* The baby is taking his daily allowance of milk in the five feedings between 7 a.m. and 11 p.m.

* The baby is not sleeping more than 4¹⁄₂ hours between 7 a.m. and 7 p.m.

BY 6–8 WEEKS

If your baby is gaining the right amount of weight each week but is still waking between 2 a.m. and 3 a.m., despite eating a good amount at the late feeding, settle him with some cool, boiled water. If he refuses to settle, you will have to feed him.

If the baby does settle, he will probably wake again around 5 a.m., at which time you can give him a full feeding, followed by a top-up at 7–7:30 a.m. This will help keep him on track with his feeding and sleeping pattern for the rest of the day.

Within a week, babies usually sleep until close to 5 a.m., gradually increasing their sleep time until 7 a.m. During this stage, when your baby is taking a top-up at 7–7:30 a.m. instead of a full feeding, he may not manage to get through to 10:45–11 a.m. for his next feeding. You may need to give him half the amount at 10 a.m. followed by the remainder at 10:45–11 a.m., followed by a top-up just before he goes down for his lunchtime nap, to ensure that he does not wake early from the nap.

BY 3–4 MONTHS

Both breast-fed and bottle-fed babies should be able to go for one long spell during the night by this age, provided they are getting their daily intake of milk between 6/7 a.m. and 10/11 p.m.

Your baby should be sleeping no more than three hours between 7 a.m. and 7 p.m.

If your baby insists on waking before 4/5 a.m. in the night, refuses cool boiled water and will not settle without eating, keep a very detailed diary listing exact times and amounts of feeding and times of daytime naps. A baby who cuts back on his 7 a.m. feeding could be waking out of habit rather than hunger.

Some breast-fed babies may still genuinely need to nurse in the night if they are not getting enough at their late feeding. If you are not already doing so, it is worth considering a top-up feeding of expressed milk or formula, or a replacement formula feeding at the late feeding.

Whether you are breast-feeding or bottle-feeding, if your baby’s weight gain is good, you are convinced he is waking from habit and he refuses cool boiled water, try leaving him for 15–20 minutes before going to him. Some babies will grumble on and off and then settle themselves back to sleep.

A baby of this age may still be waking in the night because he is getting out of his covers. Try tucking him in using two rolled-up towels wedged between the mattress and the slats of the crib to keep the sheet firm.

BY 4–5 MONTHS

If your baby reaches five months and is still waking in the night, you probably need to persevere with his routine, paying increased attention to the timings of the feedings and the amount of daytime sleep he is getting. If you feel that he is showing signs that he is ready to be weaned, consult your pediatrician for advice as to whether he should begin earlier than the recommended six months.

MILK FEEDING CHART FOR THE FIRST YEAR

AGE	TIMES
2–4 weeks	2–3 a.m. 6–7 a.m. 10–10:30 a.m. 2–2:30 a.m. 5 p.m. 6–6:30 p.m. 10–11 p.m.
4–6 weeks	3–4 a.m. 6–7 a.m. 10:30–11 a.m. 2–2:30 p.m. 5 p.m. 6–6:30 p.m. 10–11 p.m.
6–8 weeks	4–5 a.m. 7:30 a.m. 10:45–11 a.m. 2–2:30 p.m. 6–6:30 p.m. 10–11 p.m.
8–10 weeks	5–6 a.m. 7:30 a.m. 11 a.m. 2–2:30 p.m. 6–6:30 p.m. 10–11 p.m.
10–12 weeks	7 a.m. 11 a.m. 2–2:30 p.m. 6–6:30 p.m. 10–11 p.m.
3–4 months	7 a.m. 11 a.m. 2–2:30 p.m. 6–6:30 p.m. 10–10:30 p.m.
4–5 months	7 a.m. 11 a.m. 2–2:30 p.m. 6–6:30 p.m. 10 p.m.
5–6 months	7 a.m. 11:30 a.m. 2–2:30 p.m. 6–6:30 p.m.
6–7 months	7 a.m. 2–2:30 p.m. 6–6:30 p.m.
7–8 months	7 a.m. 2–2:30 p.m. 6–6:30 p.m.
8–9 months	7 a.m. 2–2:30 p.m. 6–6:30 p.m.
9–10 months	7 a.m. 5 p.m. 6:30–7 p.m.
10–12 months	7 a.m. 5 p.m. 6:30–7 p.m.

Structuring Daytime Sleep During the First Year

The whole aim of the CLB routines is to ensure that the timings of feedings fit in with your baby’s daily sleep requirements. A baby who does not eat well during the day will not sleep well during the day; and to ensure good nighttime sleep for your baby it is essential that you structure his daytime sleep. Too much sleep can result in nighttime wakings. Too little can result in an overtired, irritable baby who has difficulty settling himself to sleep and who falls asleep only when he is totally exhausted.

When following the routines it is important to remember that they are guidelines to help you decide just how long your baby can stay awake before he needs to nap. In the routines, I stress that most babies in the early days can stay awake happily for up to two hours before needing a nap. I do not say that they must stay awake for the full two hours, only that it is important, if overtiredness is to be avoided, that they do not stay awake longer than two hours. So if, during the early days, you find that your baby is only staying awake for 1–1¹⁄₂ hours at a time, you do not need to worry as he is obviously a baby that needs more sleep, and as he grows, he will start to stay awake longer.

Of course, if you have a baby who is staying awake only an hour at a time during the day and partying for several hours in the night, this is a different matter, and you may have to try harder to encourage him to stay awake longer during the day, to avoid excessive nighttime waking.

The Importance of Nap Times

Infant sleep expert Marc Weissbluth, M.D., has carried out extensive research into the nap patterns of more than 200 children. He says that napping is one of the healthy habits that sets the stage for good overall sleep and explains that a nap offers the baby a break from stimuli and allows him to recharge for further activity. Charles Schaefer, Ph.D., Professor of Psychology at Fairleigh Dickinson University in Teaneck, New Jersey, supports this and says: “Naps structure the day, shape both the baby’s and the mother’s moods, and offer the only opportunity for Mom to relax or accomplish a few tasks.”

Several leading experts on child care are in agreement that naps are essential to a baby’s brain development. John Herman, Ph.D., infant sleep expert and Associate Professor of Psychology and Psychiatry at the University of Texas, says: “If activities are being scheduled to the detriment of sleep, it’s a mistake. Parents should come after sleeping and eating.” I couldn’t agree more.

By 3–4 months, most babies are capable of sleeping 12 hours at night (with a sleepy feeding at 10 p.m.), provided their daytime sleep is no more than 3–3¹⁄₂ hours, divided between two or three naps a day. If you want your baby to sleep from 7–7:30 p.m. to 7–7:30 a.m., it is very important you structure these naps so that he has his longest nap at midday, with two shorter ones in the morning and late afternoon. While it may be more convenient to let your baby have a longer nap in the morning followed by a shorter nap in the afternoon, this can lead to problems as he gets older.

Once he reduces his daytime sleep naturally, he is most likely to cut back on his late-afternoon nap. His longest nap of the day would then be in the morning. By late afternoon, he will be exhausted and need to go to bed by 6:30 p.m. This could result in him waking at 6 a.m. If you manage to get him to have a nap in the late afternoon, you could then be faced with the problem of him not settling well at 7–7:30 p.m.

Understanding the Sleeping Routine

Morning Nap

Most babies are ready for a nap approximately two hours from the time they wake in the morning. This should always be a short nap, around 45–60 minutes. When he is between six and nine months, this nap can be shortened to 30 minutes and be closer to 10 a.m. Around 9–12 months, most babies will reduce the time of this nap or cut it out altogether. For some, this can happen as early as eight months, for others, as late as 18 months. You will know your baby is ready to drop this nap when he starts taking a long time to settle and ends up sleeping only 10–15 minutes of his 30–45 minute nap. Other telling signs that this nap may need to be cut down or perhaps dropped is when a baby is waking during his lunchtime nap, in the night or early morning, when he had previously slept well. If a baby is resisting sleep at his morning nap and for a couple of weeks manages to get through to his lunchtime nap happily, cut the morning nap out altogether. It is very important that you always start to wake him after the 30–45 minute period, even if he has only slept for 10 minutes. If you allow him to sleep past this time, you will not know whether he is ready to drop the nap. It could also cause him to sleep too little at his lunchtime nap and result in the problems discussed earlier.

SIX WEEKS ONWARD

Until a proper sleep pattern has been established, ensure that this nap takes place in a quiet room if possible. Once a proper daytime routine has been established, this nap could at times be taken in the stroller or car seat if you have to go out, but do remember to wake him after the 45 minutes.

If he is awake at 7 a.m., he may still need a 30-minute nap at 9:30 a.m. If you find that he is only sleeping 10–15 minutes and is getting through happily to his lunchtime nap, you could cut this nap out altogether. If he sleeps to 8 a.m., he should be able to get through to his lunchtime nap without the morning nap.

Lunchtime Nap

This should always be the longest sleep of the day. By establishing a good lunchtime nap, you will ensure that your baby is not too tired to enjoy afternoon activities and that bedtime is relaxed and happy. Recent research shows that a nap between noon and 2 p.m. is deeper and more refreshing than a later nap because it coincides with the baby’s natural dip in alertness. As I explained earlier, allowing a longer nap in the morning, followed by a shorter one at this time, will, in turn, affect the rest of his sleep, which can result in an early-morning awakening.

Most babies will need to sleep 2–2¹⁄₂ hours a day until they are 18–24 months old, when that time will gradually reduce to 1–1¹⁄₂ hours. By three years of age, they may not need a sleep after lunch, but they should always be encouraged to have some quiet time in their room. Otherwise, they are likely to get very hyperactive by late afternoon, which can affect the night sleep.

SIX WEEKS ONWARD

If your baby is sleeping the full 45 minutes in the morning, he should be woken after two hours. If, for some reason, his morning nap was much shorter, then you could allow him 2¹⁄₂ hours. If your baby develops a problem with his nighttime sleep, do not make the mistake of letting him sleep longer during the day.

In the early days, a lunchtime nap may sometimes go wrong, and your baby will refuse to go back to sleep. Obviously, he cannot make it through from 1 p.m. to 4 p.m. happily. I find the best way to deal with this is to allow 30 minutes after the 2:30 p.m. feeding, then a further 30 minutes at 4:30 p.m. This should stop him becoming overtired and irritable and get things back on track so that he goes to sleep well at 7 p.m. See Chapter Sixteen, Problem Solving in the First Year, for more in-depth help with this.

SIX MONTHS ONWARD

If your baby is on three meals a day, you should be aiming to move the morning nap from 9 a.m. to 9:30 a.m., and you will most likely need to adjust the lunchtime nap to 12:30–2:30 p.m. If he is sleeping less than two hours at lunchtime, check that his morning nap between 7 a.m. and noon is no more than 30 minutes.

TWELVE MONTHS ONWARD

If your baby has difficulty in settling for the nap or is waking after 1–1¹⁄₂ hours, you might have to cut the morning nap back or get rid of it altogether. Do not let him sleep after 2:30 p.m. if you want him to go to sleep at 7 p.m.

Late-afternoon Nap

This is the shortest nap of the three, and the one the baby should drop first. It is essential that your baby learn to sleep in places other than his bed as it also allows you the freedom to get out and about.

It is important that the late-afternoon nap is as close to 5 p.m. as possible in order to ensure that your baby is refreshed for his bath and bedtime routine. This will also have the domino effect of him settling well at 7 p.m. (as he will not be overtired) and make it easier for you to wake him fully and take a good feeding at the late feeding. In the early days, if he is very sleepy after the 2 p.m. feeding, allow him a short catnap of about 20 minutes and then encourage him to have another short nap in his bassinet, stroller or car seat at 4:40–5 p.m.

THREE MONTHS ONWARD

If you want your baby to go to sleep at 7 p.m., he should never sleep more than 45 minutes at this nap, and he should always be awake by 5 p.m., regardless of how long or short his sleep was. Most babies who are sleeping well at the other two naps will gradually cut back on this sleep until they cut it out altogether. If, for some reason, his lunchtime nap was cut short, you would need to allow him a short sleep now but ensure that his daily total does not exceed the amount needed for his age.

Adjusting the Routines

Birth to Six Months

I have tried many different routines over the years and, without exception, I have found the 7 a.m. to 7 p.m. routine to be the one in which tiny babies and young infants are happiest. It fits in with their natural sleep rhythms and their need to feed little and often. I urge parents to stick to the original routine whenever possible. Once your baby reaches the age of six months, is on four or five feedings a day and needs less sleep, it is possible to change the routine without affecting your baby’s natural needs for the right amount of sleep and number of feedings.

Up to the age of six months, the following points should be noted when planning a routine:

In the very early weeks, to avoid more than one waking in the night, you must fit in at least five feedings before midnight. This can only be done if your baby starts his day at 6–7 a.m.

An 8 a.m. to 8 p.m. routine in the first few weeks would mean your baby would end up feeding twice between midnight and 7 a.m.

Six Months Onward

From six months, when your baby has started solids and you have dropped the late feeding, it is easier to adjust the routine. If your baby has been sleeping regularly to 7 a.m., it could be possible to change to a 7:30 a.m. or 8 a.m. start and push the rest of the routine forward. Your baby would obviously need to go to sleep later in the evenings. If you want your baby to sleep later but still go to bed at 7 p.m., try the following:

Cut back on the morning nap, so that your baby is ready to go to bed at 12–12:30 p.m.

Allow a nap of no longer than two hours at lunchtime and no late-afternoon nap.

Out and About

In the first few weeks, most young babies will go to sleep the minute they are in the car or the stroller. If possible, organize trips away from home during the sleep times so that the routine is not too disrupted. Once the routine is established and your baby is closer to eight weeks old, you will find that you are able to go out more often without him falling asleep the whole time.

If you are planning a daylong excursion, depending upon the length of the planned event or appointment, you can usually work it into the routine by traveling between 9 a.m. and 10 a.m., or 1 p.m. and 2 p.m. By the time you arrive at the destination, the baby will be due for a feeding and can be kept awake. Likewise, by making the return journey between 4 p.m. and 5 p.m. or after 7 p.m., you should manage to keep things on track.

GUIDE TO SLEEP REQUIRED DURING THE FIRST YEAR

Important Recommendations

The most recent advice from the Academy of American Pediatrics is that parents should allow their infants to room share, meaning sleep in their own bassinet or crib, in the room where their parents are. They recommend that the safest place for a baby to sleep is in a bassinet, crib or baby carrier, and that babies should be checked regularly when asleep. It is safest only to have bedclothes in the bed, and no objects such as toys or extra blankets. They also advise that a car seat is not an ideal place for infants to sleep in the home.

It is also important to remember that these recommendations are only for the first six months, and that after that time, you can start to settle your baby in his own room for naps and nighttime sleep. Until your baby reaches six months, you will have to alter the bedtime routine after his bath, so that you can finish off the remainder of the bedtime routine in the room where the baby is being settled to sleep for the evening. Replicate the same atmosphere in the living area as you would in the bedroom by keeping everything calm and quiet. It is unlikely that you will have a crib both upstairs and downstairs, therefore, according to the AAP, a bassinet with a proper mattress would be an acceptable option. (Throughout this book, in all routines up to six months, I refer to your baby’s place of sleep as his “bed,” which could be a bassinet, stroller or crib—or wherever he is settled to sleep.)

It is important to follow the same guidelines for settling your baby in the bassinet as those given for settling your baby in a crib. The baby should be placed in the bassinet with his feet at the bottom and it is essential that any sheets and blankets are tucked in securely so that they cannot work their way loose while he is sleeping.