16

Problem Solving in the First Year

The advice in this book is based on the hundreds of babies I have personally cared for. Each baby is an individual, and it is natural that problems may occur. Drawing on the feedback from my Web site and consultancy service, I have focused on the most common problems encountered by parents during the first year, and this chapter should cover the majority of your concerns. Remember to consult your pediatrician with any worries—even if they seem small and you fear looking like a neurotic mother. It’s better that you are not beset with worries and can enjoy your baby and this precious first year together.

I have divided the information in this chapter into three sections—general, feeding and sleeping problems—but many of them overlap. Sleeping and feeding are interdependent, so you may find it more helpful to read both of those sections.

General Problems

Burping

It is important to follow your baby’s lead regarding when to stop and burp him during feeding. If you constantly interrupt his meal trying to burp him, he will more likely get so upset and frustrated that the crying will cause more wind than the feeding itself. Time and time again, I watch babies being thumped endlessly on the back, the mother refusing to continue with the feeding as she is convinced the baby has gas. The reality is that very few babies need to be burped more than once during a feeding and once at the end.

A breast-fed baby will pull himself off the breast when he is ready to burp. If he has not done so by the end of the first breast, you can try burping him before putting him on the second breast. Bottle-fed babies will normally drink half to three-quarters of their bottle and pull themselves off to be burped. Regardless of whether you are breast-feeding or bottle-feeding, if you adopt the correct holding position as illustrated in Chapter Three, Milk Feeding in the First Year, your baby should bring his gas up quickly and easily both during and at the end of the feeding. If your baby does not bring up the wind within a few minutes, it is best to try again later. More often than not, he will bring it up after he has been laid flat for his diaper change.

Occasionally, a baby passing excessive gas from his rear end can suffer considerable discomfort and become very distressed. A breast-feeding mother should keep a close eye on her diet to see if a particular food or drink is causing the gas. Citrus fruits or drinks taken in excess by the mother can sometimes cause severe gas in babies. The other culprits are chocolate and excessive dairy intake.

Special care should be taken to make sure that the baby is reaching the hind milk. Too much fore milk can cause explosive bowel movements and excessive passing of gas.

With a bottle-fed baby who is already feeding from special anticolic bottles, the cause of excessive gas is usually overfeeding. If your baby is regularly drinking 3–6 oz. a day more than the amount advised on the packet and constantly putting on in excess of 8 oz. of weight each week, cut back on a couple of his feedings (either the 2:30 p.m. or 5 p.m.) for a few days to see if there is any improvement. A “sucky” baby could be offered a pacifier after the smaller feedings to satisfy his sucking needs.

Sometimes a nipple with a hole either too small or too large for your baby’s needs can cause excessive gas. Experiment with the different sizes of nipples; sometimes using a smaller hole at a couple of the feedings can help a baby who is drinking some of his feedings too quickly.

Colic

Colic is a common problem for babies less than three months. It can make life miserable for the baby and the parents, and to date, there is no cure for it. There are over-the-counter medications, but most parents with a baby suffering from severe colic say that they are of little help. Although a baby can suffer from colic at any time of the day, the most common time seems to be between 6 p.m. and midnight. Parents resort to endless feeding, rocking, patting, driving the baby around the block, most of which seem to bring little or no relief. Colic usually disappears by four months of age; but by that time, the baby has often learned all the wrong sleep associations, so the parents are no further ahead.

Parents who contact me for help with their colicky baby describe how the baby screams, often for hours at a time, thrashes madly and keeps bringing his legs up in pain. These babies seem to have one thing in common: They are all being fed on demand. Feeding this way all too often leads to the baby having a feeding before the first one has been digested, one of the causes, I believe, of colic.

Not one of the babies I have cared for has ever suffered from colic, and I am convinced that it is because I structure their feeding and sleeping from day one. When I do go in to help an older baby who is suffering from colic, it seems to disappear within 24 hours of him being put on the routine.

First, I would check that colic was being caused by demand-feeding and not the mother’s diet. Then, depending upon the age of the baby, the symptoms, and how often he was feeding throughout the evening and the middle of the night, I would introduce sugar water. With a baby between one and three months of age who was feeding excessively in the night and consistently putting on more than the recommended weight gain each week, I would replace one of the night feedings with some sugar water. When the baby woke in the night, I would give 2 oz. of cool boiled water mixed with half a teaspoon of sugar to settle him. At this stage, I find plain boiled water does not have the same effect. The following day I would wake the baby at 7 a.m., regardless of how little sleep he had in the night, and then proceed with the routine throughout the day until 6:30 p.m. At this time, I would always offer a breast-fed baby a top-up of expressed milk to ensure that he has had enough to drink. This avoids his need to feed again in two hours, which is a common pattern of babies suffering from colic. With a bottle-fed baby I always make sure that the 2:30 p.m. feeding is smaller so that he eats well at 6:30 p.m.

With a baby of three months or more, I would attempt to eliminate middle-of-the-night feedings altogether or at least reduce the feeding to only one. In both cases, it is important to ensure that the baby eats well at 6:15 p.m., if necessary by offering a top-up of expressed milk at this time. A low milk supply in the early evening is often the cause of a baby feeding little and often, which can lead to him not digesting properly.

More often than not, the baby settles well the first night, but occasionally I worked with a baby who had developed the wrong sleep associations as a result of colic. With these babies I used the crying-down method of sleep training and within 3–4 nights they were going down happily and sleeping well until the late feeding. Because they had slept well and had gone a full four hours since their last feeding, they fed well and went on to last for an even longer spell in the night. Depending upon their age, they were given either a feeding or sugar water. A baby of three months or older who is capable of going from the last feeding through to 6–7 a.m. should be given sugar water for a week. Once the pattern of once-a-night waking is established, gradually reduce the amount of sugar until he is taking plain water.

This method, along with the routines, will encourage a baby who has suffered from colic and developed the wrong sleep associations to sleep through the night, normally within a couple of weeks. I cannot stress strongly enough that the success of this method very much depends upon the use of the sugar water during the first week. Plain water does not have the same success. I picked up this tip from an older maternity nurse more than 25 years ago, and it has never failed me. Parents are often concerned that it will encourage their babies to develop a sweet tooth, or even worse, rot their teeth. Because of the short period the sugar water is used, I have never seen any of these problems evolve. I am also pleased to say that my advice has now been backed up by recent research on colic by Dr. Peter Lewindon of the Royal Children’s Hospital, Brisbane, Australia. Research shows that sugar stimulates the body’s natural painkillers and that some babies suffering from colic can be helped by the sugar water solution.

Crying

According to the American Academy of Pediatrics, newborns routinely cry a total of 1–4 hours a day. With very young babies, I have noticed that they do go through unsettled stages around 3–6 weeks, which tends to coincide with growth spurts. However, I would be absolutely horrified if any of my babies cried for even one hour a day, let alone 2–4 hours! The one thing that parents comment upon time and time again is how happy their baby is on the routine. Of course, my babies do cry; some when they have their diaper changed, others when having their face washed, and a few when fighting sleep when put in their crib. With the ones that fight sleep, because I know that they are well fed, burped and ready to sleep, I am very strict. I let them fuss and yell for 10–12 minutes until they have settled themselves. This is the only real crying I experience, and even then, it occurs with the minority of my babies and lasts for no longer than a week or two. Understandably, all parents hate to hear their baby cry; many are worried that to put their baby in a crib to sleep and leave him to cry like this could be psychologically damaging. I would like to reassure you that, provided your baby has been well fed, and you have followed the routines regarding awake periods and winding-down time, your baby will not suffer psychological damage. In the long term, you will have a happy, contented baby who has learned to settle himself to sleep. Many parents who have followed the demand method with the first baby, and my routines with their second baby, would confirm wholeheartedly that my methods are by far better and, in the long term, easier.

Marc Weissbluth, M.D., Director of the Sleep Disorders Center at the Children’s Memorial Hospital, Chicago, says in his book, Healthy Sleep Habits, Happy Child that parents should remember they are allowing their baby to cry, not making him cry. He also says that it will be much harder for an older baby to learn how to settle himself. Therefore, do not feel guilty or cruel if you have to allow a short spell of crying when your baby is going to sleep. He will very quickly learn to settle himself as long as you have made sure he is well fed and has been awake long enough but not so long that he has become overtired.

Following are the main reasons a healthy baby would cry. Use them as a checklist. At the top of that list is hunger. A tiny baby who is hungry should always be fed, regardless of routines.

Hunger

When your baby is very tiny and fretful and unsettled, it is, of course, wise to assume that when he cries the problem is hunger and to offer him milk or formula, even if it is before the time recommended in the routine for his age. One of the main reasons that I find very young breast-fed babies are unsettled in the evening is usually hunger. If your baby eats well, stays awake for a short spell after feedings, then sleeps well until the next feeding but is unsettled in the evening—it is very possible the cause is hunger. Even if your baby is putting on a good amount of weight each week, you should not rule out hunger. Many mothers I know can produce a lot of milk early on in the day, but come the evening, when tiredness has crept in, the milk supply can decrease dramatically. I would strongly recommend that, for a few nights, you try topping him up with a small amount of expressed milk after his bath. If he settles well then you will know that your milk supply is low at that time of the evening. Please check “Low Milk Supply” later in this chapter for suggestions on how to deal with this problem.

However, if you find that your baby is unsettled in the evening, or indeed any other time of the day, despite being well fed, it is important that you eliminate other reasons for his fretfulness. During my many years of caring for young babies, I did have a handful who were very fretful in the early days, no matter what I did to help calm them. If I had a very unsettled baby I would go through every possibility before accepting that there was nothing I could do to help. Babies do have many needs other than feeding, sleeping and being held.

Tiredness

Babies less than six weeks tend to get tired after one hour of being awake. Although they may not be quite ready to sleep, they need to be kept quiet and calm. Not all babies show obvious signs of tiredness, so in the early days, after your baby has been awake for one hour, I still advise that you take him to his room, so he can wind down gradually. If you can’t do that, at least try to keep him in a peaceful part of the house. Try not to allow visitors to overstimulate a baby during this winding-down period.

Overtiredness

No baby less than three months should be allowed to stay awake for more than two hours at a time, as he can become very overtired and difficult to settle.

Overtiredness is often a result of overstimulation. An overtired baby reaches a stage at which he is unable to drift off to sleep naturally, and the more tired he becomes, the more he fights sleep. A baby younger than three months who is allowed to get into this state and stays awake for more than two hours can become almost impossible to settle.

In a situation like this sometimes a short period of crying down has to be used as a last resort to solve the problem. This is the only situation when I would advise that young babies should be left to cry for a short period, and even then, it can only be done if you are confident that the baby has been well fed and burped.

Boredom

Even a newborn baby needs to be awake some of the time. Encourage him to be awake for a short spell after his day feedings. Babies less than one month love to look at anything black and white, especially pictures of faces, and the ones that fascinate them most will be the faces of their parents. Divide the toys into ones that are used for wakeful periods and ones that are used for winding-down time. Bright, noisy ones for social time; calm, soothing ones for sleepy times.

Gas

All babies pass a certain amount of gas while feeding, bottle-fed babies more so than breast-fed ones. Given the opportunity, most babies bring up their gas easily. If you suspect that your baby’s crying is caused by gas, check that you are allowing enough time between feedings. I have found overfeeding and demand-feeding to be the main causes of colic in young babies. A breast-fed baby needs at least three hours to digest a full feeding, and a formula-fed baby should be allowed 3¹⁄₂–4 hours. This time is always from the beginning of one feeding to the beginning of the next one.

I would also suggest that you keep a close eye on your baby’s weight gain. If his weight gain exceeds 8–10 oz. a week and he appears to be suffering from gas pains, it could be that he is overfeeding, particularly if he weighs more than 8 lbs. and is feeding 2–3 times in the night. For details on how to deal with this problem refer to Chapter Three, Milk Feeding in the First Year.

Pacifiers

I have always believed that, if used with discretion, a pacifier can be a great asset, especially for a sucky baby. The Mayo Clinic reports on its Web site that to reduce the risk of SIDS, the American Academy of Pediatrics recommends offering a pacifier at nap time or bedtime until age one. However, I have always stressed the importance of never allowing the baby to have the pacifier in his crib or of allowing him to suck himself to sleep on the pacifier. My advice was that it is fine to use it to calm a baby and, if necessary, settle him at sleep times, but it must be removed before he falls asleep. In my experience, allowing a baby to fall asleep with a pacifier in his mouth is one of the worst sleep-association problems to solve. He can end up waking several times a night, and each time he will expect the pacifier to get back to sleep.

There are two types of pacifiers available: one has a round cherry-type nipple; the other has a flat-shaped nipple, which is called an orthodontic nipple. Some experts claim that the orthodontic nipple shape is better for the baby’s mouth, but the problem with this type is that most young babies cannot hold them in for very long. I tend to use the cherry-type nipple, and so far, none of my babies appears to have developed an overbite, which is often the result of a pacifier being used excessively once the teeth have come through. Whichever type of pacifier you choose, buy several so that they can be changed frequently. The utmost attention should be paid to cleanliness when using a pacifier; it should be washed and sterilized after each use. Never clean it by licking it, as so many parents do; there are more germs and bacteria in the mouth than you would believe.

Hiccups

Hiccups are very normal among tiny babies, and very few become distressed by them. Hiccups often happen after a feeding. If it has been a nighttime feeding and your baby is due to go down for a sleep, it is advisable to go ahead and put him down regardless. If you wait until the hiccups are finished, there is a bigger chance of him falling asleep in your arms, which is something to be avoided at all costs. If your baby is one of the rare ones who gets upset by hiccups, then try giving him the recommended dose of gripe water, which can sometimes help.

Spitting Up

It is very common for babies to bring up a small amount of milk while being burped or after a feeding. It is called spitting up, and for most babies it does not create a problem. However, if your baby is regularly gaining more than 8 oz. of weight each week, spitting up could be a sign that he is drinking too much. With a bottle-fed baby, the problem is easily solved as you are able to see how much the baby is drinking and, therefore, slightly reduce the amount at the feedings during which he appears to spit up more. It is more difficult to tell how much a breast-fed baby is drinking. But by keeping a note of which feedings cause more spitting up and reducing the time on the breast at those feedings, the spitting up may be reduced.

If your baby is spitting up excessively and not gaining weight it could be that he is suffering from a condition called reflux (see the next section). With babies who are inclined to bring up milk, it is important to keep them as upright as possible after a feeding and special care should be taken when burping.

Any baby bringing up an entire feeding twice in a row should be seen by a doctor immediately.

Reflux

Sometimes a baby displaying all the symptoms of colic actually has a condition called gastroesophageal reflux. Because the muscle at the lower end of the esophagus is too weak to keep the milk in the baby’s stomach, it comes back up, along with acid from the stomach, causing a very painful burning sensation in the esophagus. Excessive spitting up is one of the symptoms of reflux. However, not all babies with reflux actually spit up the milk; some suffer from what the medical profession calls silent reflux. These babies are often misdiagnosed as having colic. They can be very difficult to feed, constantly arching their backs and screaming during a feeding. They also tend to become very irritable when laid flat, and no amount of cuddling or rocking will calm them when they are like this. If your baby displays these symptoms, insist that your doctor does a reflux test. I have seen too many cases of babies being diagnosed as having colic, when in fact they were suffering from reflux. If you think that your baby is suffering from reflux, it is essential that you do not allow anyone to dismiss the pains as colic. Reflux is very stressful for the baby and parents, and it is essential that you get ongoing advice and support from your doctor. If you feel that you are not getting the help you need, do not be afraid to ask for a second opinion. If reflux is not the problem, you will at least have eliminated it as a possible cause. If it is the problem, with the right medication your baby will have been saved months of misery. It is important that a baby with reflux is not overfed and is kept as upright as possible during and after feeding. Some babies may need medication for several months until the muscles of the esophagus tighten up. Fortunately, the majority of babies outgrow the condition by the time they are one year old.

If your baby is diagnosed with reflux, it is worth looking at the reflux section on my Web site www.contentedbaby.com. There you will find case studies, plus lots of advice and tips on how to survive those early months with a reflux baby.

Separation Anxiety

At about the age of six months, babies start to gain more understanding of their environment and begin to realize that they are separate from their mother. Between the ages of 6 and 12 months, most babies show some signs of separation anxiety. You may find that your happy, contented baby, who was so easygoing and relaxed, suddenly becomes clingy, anxious and demanding, and starts crying the minute you leave the room.

This sudden change of your baby’s temperament can be very upsetting, but do be reassured that this behavior is a totally normal part of a baby’s development. All babies go through this stage to some degree.

Although this stage can be a very exhausting time for you, it rarely lasts long. The following guidelines can help make this difficult period less stressful:

A comforter can be very reassuring to babies and can provide a consistent comforting familiarity. Consider introducing one if your child hasn’t already made an attachment. Often a baby will choose his own comforter, and these are generally a familiar object with comforting associations, such as a soft toy, a crib blanket or a burp cloth. If you choose to guide your baby, choose a toy that can be replaced (a spare cuddly toy that is interchanged regularly is a very sensible precaution). You should also think of the practicalities. Safety is paramount—you need to make sure that the comforter has no loose pieces that could prove a choking hazard. It should be washable and durable. It is extremely distressing for both your baby and you if the comforter is mislaid, so it might be worth encouraging your baby to leave the comforter at home on trips to the park or on play dates.

Aim to get your baby used to whatever child care you have chosen. Ideally give both of you one month to become accustomed to the situation. Lengthen the time you leave the baby in stages.

The longer you give yourself and your child the time to get used to a separation, the more flexibility you will have. For instance, if your baby is inconsolable by your departure, you might delay trying to leave him again for a week or so. With such a young child, every day adds to his confidence and understanding, and it might be that if you wait a week or so, your baby will have a different response next time you leave him.

If your baby has a particular activity he enjoys—hitting a saucepan with a spoon or playing with a particular toy—have your baby’s child-care provider have something similar to offer.

Try role-playing. Even very young babies can grasp the concept of people or toys leaving and returning. Maybe encourage your baby to say “good-bye” to a doll or teddy bear, and then “hello.”

Praise your child when he is prepared to go with your child-care provider.

Talk to your baby. It is extraordinary how much a little baby can take in. If your baby is used to his father leaving for work each day, keep repeating: “Daddy has gone to work.” This will reinforce his confidence that when the time comes for Mommy to go to work, she will also be returning.

When you prepare to leave your baby, make sure that you keep your good-bye to a minimum. Be positive, use reassuring phrases and smile; this will help to reassure him. Try a hug and kiss and a verbal reminder that you will be back soon. Using the same approach and words each time you say good-bye will, in the long term, be more reassuring than going back to calm him. While a baby will often cry when a parent leaves the room, most children will be easy to distract in the hands of a competent caregiver. However, babies are sensitive to moods, and if you are anxious and worried, your baby will pick up on this and be more likely to be upset.

Avoid just slipping away when you leave your baby. Although you will find it difficult if he is upset when you say good-bye, it is much better for him to understand that you are going and that you will return rather than for him to look around later to find that you have vanished. This could contribute to his unhappiness—he might become confused and clingy.

Be realistic—you might well find that your baby is fretful at home even though the caregiver has told you that he is happy and content when you are not there. In the same way that you will find the change to your routine tiring, so will your baby. Don’t worry; provided that the circumstances are loving and secure, babies are adaptable.

During this period of adjustment, ask your baby’s caregiver to ensure that your baby is not subjected to too many new experiences or handled by strangers. The calmer and more predictable his routine, the quicker he will get over his feelings of anxiety.

If your baby is used to just being with you for the first six months, you can imagine that adapting to a livelier environment can be challenging. If you have chosen a child-care provider who also looks after other children, your baby will need to adapt to a noisier, more dynamic environment than he is used to. You can help your baby by arranging regular play dates with a small group of mothers and babies. Not only will this be enjoyable for you, but also it will enable your baby to get used to the noise and activity of other children. If you have a nervous baby, you will find that he will become happier once he is used to a different environment. Gradually introduce him to larger groups and other experiences. Generally babies love the activities of toddlers so, providing that they are appropriately monitored, you can feel reassured that it will be a pleasant experience for him.

Stranger Anxiety

At around six months, you might also find that your sociable baby is wary of strangers. This is a natural part of his development. It is thought that this fear of strangers is a biological protective response relating to our origins. It contributed to a baby’s ability to survive in a primitive environment.

We have an expectation that babies are happy to be handed to loving relatives and friends for cuddles when they are small, but even small babies can find that being passed from one loving relative to the next is tiring and distressing.

If your baby begins to cry when approached by strangers or to look away when someone is trying to engage him, don’t attempt to push him to communicate. It is much better to explain that your child is becoming self-conscious and having a shy period than to expect your baby to smile on cue!

You can ease this response to those friends and family you see regularly by talking to your baby about them. If you have a photo-montage on the wall, you can show your baby photographs and explain who they are.

For those grandparents or family who see your baby more occasionally, it can be upsetting when your child is distressed or tearful but be reassured that any initial concern will not last long if you are in a position to spend some time together.

Role-play can also help in this circumstance; try giving your baby’s toys the names of the friends and family with whom you want him to be familiar.

Consider asking friends to not make too much fuss over your baby upon first arriving. Sometimes a baby can find their physical proximity threatening, and it is easier if the baby is allowed to respond in his own time, when he feels comfortable with the new person, rather than when someone is attempting to make eye contact and communicate.

Although your baby will learn how to deal with greetings and attention as he grows up, some children remain shy. It is much better for you to adapt to this and try to understand how it feels to be a shy child, rather than pushing your child into situations in which he feels uncomfortable or distressed.

Common Feeding Problems

Difficult Feeder

The majority of newborn babies take to the breast or bottle quickly and easily. Unlike the new mother, who has much to learn about feeding, the baby instinctively knows what is expected of him. However, there are some babies who, from day one, will fuss and fret within minutes of being put on the breast or being offered the bottle. I often find that some babies who have undergone a particularly hard birth can be more difficult to feed.

If you find that your baby becomes tense and fretful at feeding times, try to avoid having visitors then. No matter how well-meaning family and friends may be, it will be impossible to keep things completely calm and quiet if you are having to make conversation. The following guidelines, regardless of whether you are breast- or bottle-feeding, should help make feeding a tense baby easier:

It is essential that the handling of tense babies is kept to the minimum. Avoid overstimulation and handing the baby from person to person, especially before a feeding.

Whenever possible, try to nurse in a quiet room with a calm atmosphere. Apart from perhaps one person to offer practical help and emotional support, no other person should be allowed in the room.

Prepare everything needed for the feeding well in advance. Try to make sure that you have rested and eaten.

Avoid turning on the television during a feeding; unplug the telephone and play some calm music while feeding.

When the baby wakes for his feeding, do not change his diaper as this may trigger crying.

Try swaddling him firmly in a soft receiving blanket to prevent him from thrashing his arms and legs around. Make sure that you are comfortable before you start feeding.

Do not attempt to latch the baby onto the breast or put the bottle straight in his mouth if he is crying. Hold him firmly in the feeding position and calm him down with continuous gentle patting on the back.

Try holding a pacifier in his mouth. Once he has calmed down and has sucked steadily for a few minutes, then very quickly ease the pacifier out and offer him the breast or the bottle.

If you find your baby is fussy when feeding and taking a lot longer than an hour to eat, try allowing him a short break halfway through the feeding. It is better to let your baby eat in two shorter spurts than spend a lengthy time trying to force him to eat.

If your baby has been eating well and suddenly starts to refuse the breast or bottle, it could be because he is feeling unwell. Ear infections can easily go undetected and are a very common cause of a baby not wanting to eat. If your baby shows any of the following signs it would be advisable to consult your doctor:

Sudden loss of appetite, and becoming upset when offered a feeding.

Disruption to the normal sleep pattern.

Suddenly becoming clingy and whiney.

Becoming lethargic and unsociable.

Low Milk Supply

As they grow, all babies will drink more. However, the feedings must be structured to coordinate with the baby’s growth, thereby encouraging him to take more milk at each feeding. If not, he will be very likely to continue to feed little and often.

All too often, I get calls from the parents of older babies who are still following the demand rules of milk feeding. While the majority of these babies are more than 12 weeks old and are physically capable of drinking more at individual feedings, they continue to nurse as they did as newborns—often 8–10 times a day.

Many breast-fed babies are still having only one breast at each feeding, while bottle-fed babies may be taking only 3–4 oz. of formula. In order to go for longer spells between feedings, these babies should be taking from both breasts at each feeding, or have a formula feeding of 7–8 oz. It is my firm belief that it is during those early days of milk feeding that the foundation is laid for healthy eating habits in the future. To avoid long-term feeding problems that can affect your baby’s sleep, it is advisable to structure and solve any milk-feeding problems early on.

Not producing enough milk, especially later in the day, is a very common problem for breast-feeding mothers and one of the major reasons breast-feeding goes wrong. I believe that hunger is why so many babies are fretful and difficult to settle in the evening. If the problem of a low milk supply is not resolved in the early days, then a pattern soon emerges of the baby needing to feed on and off all evening to satisfy his needs. Mothers are advised that this constant feeding is normal and the best way to increase the milk supply, but in my experience, it usually has the opposite effect. Because the amount of milk the breasts produce is dictated by the amount of milk the baby drinks, these frequent feedings signal the breasts to produce milk little and often. These small feedings will rarely satisfy the baby, leaving him hungry and irritable.

I believe that the stress involved in frequently feeding a very hungry, irritable and often overtired baby can cause many mothers to become so exhausted that their milk supply is reduced even further. Exhaustion and a low milk supply go hand in hand. I am convinced that by expressing a small amount of milk during the early weeks of breast-feeding, when the breasts are producing more milk than the baby needs, the mother can help avoid the problem of a low milk supply.

If your baby is less than one month of age and not settling in the evening, it is possible the cause is a low milk supply. Expressing at the times I suggest should help solve this problem. The short amount of time you spend expressing will ensure that during any future growth spurts you will be producing enough milk to meet any increase in your baby’s appetite. If your baby is more than one month and not settling in the evening or after daytime feedings, the following six-day plan will quickly help to increase your milk supply. The temporary introduction of top-up feedings will ensure that your baby is not subjected to hours of irritability and anxiety caused by hunger, which is what usually happens when mothers resort to demand feeding to increase their milk supply.

Plan for Increased Milk Supply

Days One to Three

6:45 A.M.

Express 1 oz. from each breast.

Baby should be awake, and eating no later than 7 a.m., regardless of how often he nursed in the night.

He should be offered up to 20–25 minutes on the full breast, then up to 10–15 minutes on the second breast.

Do not feed after 7:45 a.m. He can stay awake for up to two hours.

8 A.M.

It is very important that you have a breakfast of cereal, toast and a drink no later than 8 a.m.

9 A.M.

If your baby has not been settling well for his nap, offer him up to 5–10 minutes on the breast from which he last fed.

Try to have a short rest when the baby is sleeping.

10 A.M.

Baby must be fully awake now, regardless of how long he slept.

He should be given up to 20–25 minutes from the breast he last fed on while you drink a glass of water and have a small snack.

Express 2 oz. from the second breast, then offer him up to 10–20 minutes on the same breast.

11:45 A.M.

He should be given the 2 oz. that you expressed to ensure that he does not wake hungry from his midday nap.

It is very important that you have a good lunch and a rest before the next feeding.

2 P.M.

Baby should be awake and eating no later than 2 p.m., regardless of how long he has slept.

Give him up to 20–25 minutes from the breast he last nursed from while you drink a glass of water. Express 2 oz. from the second breast, and then offer up to 10–20 minutes on the same breast.

4 P.M.

Baby will need a short nap according to the routine appropriate for his age.

5 P.M.

Baby should be fully awake and eating no later than 5 p.m.

Give up to 15–20 minutes from both breasts.

6:15 P.M.

Baby should be offered a top-up of expressed milk from the bottle. A baby less than 8 lbs. in weight will probably settle with 2–3 oz.; bigger babies may need 4–5 oz.

Once your baby is settled, it is important that you have a good meal and a rest.

8 P.M.

Express from both breasts.

10 P.M.

It is important that you express from both breasts at this time, as the amount you get will be a good indicator of how much milk you are producing.

Arrange for your partner or another family member to give the late feeding to the baby so you can have an early night.

10:30 P.M.

Baby should be awake and eating no later than 10:30 p.m. He can be given a full feeding of either formula or expressed milk from a bottle. Refer to Chapter Three, Milk Feeding in the First Year, for details of the amounts to give.

In the Night

A baby who has had a full feeding from the bottle at 10:30 p.m. should feel satisfied until 2–2:30 a.m. He should then be offered 20–25 minutes from the first breast, then 10–15 minutes from the second. In order to avoid a second waking in the night at 5 a.m., it is very important that he nurses from both breasts.

If your baby ate well at 10:30 p.m. and wakes earlier than 2 a.m., the cause may not be hunger. The following are other reasons which may be causing him to wake earlier.

Kicking off the covers may be the cause of your baby waking earlier than 2 a.m. A baby less than six weeks who wakes thrashing around may still need to be fully swaddled. A baby more than six weeks may benefit from being half-swaddled under the arms in a thin cotton sheet. With all babies, it is important to ensure that the top sheet is tucked in well, down the sides and at the bottom of the crib.

The baby should be fully awake at the late feeding. With a baby who is waking before 2 a.m., it may be worthwhile keeping him awake longer, and offering him some more milk just before you settle him at around 11:15 p.m.

Day Four

By day four, your breasts should be feeling fuller in the morning and the following alterations should be made to the plan:

If your baby is sleeping well between 9 a.m. and 9:45 a.m., reduce the time on the breast at 9 a.m. to five minutes.

The top-up at 11:45 a.m. can be reduced by 1 oz. if he is sleeping well at lunchtime or shows signs of not feeding well at the 2 p.m. feeding.

The expressing at the 2 p.m. feeding should be dropped, which should mean that your breasts are fuller at 5 p.m.

If you feel your breasts are fuller at 5 p.m., make sure he totally empties the first breast before putting him onto the second breast. If he has not emptied the second breast before his bath, he should be offered it again after the bath, and before he is given a top-up.

The 8 p.m. expressing should be dropped and the 10 p.m. expressing brought forward to 9:30 p.m. It is important that both breasts are completely emptied at the 9:30 p.m. expressing.

Day Five

Dropping the 2 p.m. and 8 p.m. expressing on the fourth day should result in your breasts being very engorged on the morning of the fifth day; it is very important that the extra milk is totally emptied at the baby’s first meal in the morning.

At the 7 a.m. feeding, the baby should be offered up to 20–25 minutes on the fuller breast, then up to 10–15 minutes on the second breast, after you have expressed. The amount you express will depend upon the weight of your baby. It is important that you take just the right amount so that enough is left for your baby to get a full feeding. If you managed to express at least 4 oz. at the late feeding, you should manage to express the following amounts:

(a) Baby weighing 8–10 lbs.—express 4 oz.

(b) Baby weighing 10–12 lbs.—express 3 oz.

(c) Baby weighing more than 12 lbs.—express 2 oz.

Day Six

By the sixth day, your milk supply should have increased enough for you to drop all top-up feedings and follow the breast-feeding routines appropriate for your baby’s age. It is very important that you also follow the guidelines for expressing as set in the routines. This will ensure that you will be able to satisfy your baby’s increased appetite during his next growth spurt. I would also suggest that you continue with one bottle of either expressed or formula milk at the late feeding until your baby is introduced to solids at six months. This will allow the feeding to be given by your husband or partner, enabling you to get to bed after you have expressed, which, in turn, will make it easier for you to cope with the middle-of-the-night feeding.

Excessive Night Feeding

I have found that all babies, even demand-fed babies, are capable of sleeping one longer spell between feedings by the time they reach 4–6 weeks of age. Beatrice Hollyer and Lucy Smith, authors of the excellent book Sleep: The Secret of Problem-free Nights, describe this longer stretch of sleep as the “core night.” They advise parents to take their cue from this longer stretch of sleeping, which they believe is the foundation of encouraging a baby to sleep right through the night.

I believe that by the end of the second week a baby who weighed 7 lbs. or more at birth should really only need one feeding in the night (between midnight and 6 a.m.). This is provided, of course, that he is eating well at all of his daytime feedings and gets a full feeding between 10 p.m. and 11 p.m. In my experience, regardless of whether he is breast- or bottle-fed, a baby who continues to nurse 2–3 times in the night will eventually begin to cut back on his daytime feedings. A vicious circle soon emerges, in which the baby ends up genuinely needing to eat in the night so that his daily nutritional needs can be met.

With bottle-fed babies, it is easier to avoid a pattern of excessive nighttime feeding by monitoring the amounts they are getting during the day. Calculate how much milk your baby needs each day for his weight. Then use the example chart in Chapter Three, Milk Feeding in the First Year, to see how to structure feedings, so the biggest feedings are at the night times. This, as well as the core-night suggestions (later in this section), will prevent excessive night feeding for a formula-fed baby.

Excessive nighttime feeding is considered normal for breast-fed babies and is actually encouraged by many breast-feeding experts. Mothers are advised to have their baby sleep with them, so that he can feed on and off throughout the night. Much emphasis is placed on the fact that the hormone prolactin, which is necessary for making breast milk, is produced more at night. The theory is that mothers who nurse their babies more in the night than in the day are much more likely to sustain a good milk supply. This advice obviously works for some mothers, but breast-feeding statistics prove that it clearly doesn’t for many others, as so many give up in the first month. As I’ve said, I believe that the exhaustion caused by so many nighttime feedings is one of the main reasons why so many mothers give up altogether.

In my experience from working with hundreds of breast-feeding mothers, I have found that a good stretch of sleep in the night results in the breasts producing more milk. A full and satisfying feeding in the middle of the night will ensure that the baby settles back to sleep quickly until the morning.

The following list gives the main causes of excessive nighttime feeding and how to avoid it:

A premature baby or a very tiny baby would need to feed more often than every three hours, and medical advice should be sought on how best to deal with these special circumstances.

If he nurses well at every feeding (a baby more than 8 lbs. should always be offered the second breast) and is sleeping well at all the other sleep times, he may not be getting enough from the late feeding.

If a low milk supply at the last feeding is the problem, it can easily be solved by ensuring your baby takes a full feeding from a bottle of either formula or expressed milk.

Many women are concerned that introducing a bottle too early may reduce the baby’s desire to take the breast. All of my babies are offered one bottle a day as a matter of course, and I have never had one baby who had nipple confusion or refused the breast. An occasional bottle has the added advantage that the partner can give the last feeding and enable the mother to get to bed by 10 p.m.

If after one week of giving a full feeding late in the evening, there is no improvement, and your baby is still waking several times a night, it is more likely that he has a problem with his sleeping than with his eating. I suggest that you continue to offer the bottle for a further week and refer to “Excessive Night Waking” in this chapter for more advice on the subject.

Babies less than 8 lbs. who are changed to the second breast before reaching the fatty, rich hind milk in the first breast will be more likely to wake more than once in the night.

If a baby weighs more than 8 lbs. at birth and is only to nurse from one breast at a feeding, then he may not be getting enough milk and should be offered the second breast at some or all of his feedings. If he has nursed for 20–25 minutes on the first breast then try to get him to take 5–10 minutes from the second. If he refuses, try waiting 15–20 minutes before offering it again.

The majority of the babies on my routines who are feeding only once in the night gradually push themselves right through to morning, dropping the middle-of-the-night feeding as soon as they are physically capable. However, occasionally I get a baby who reaches six weeks and continues to wake at 2 a.m. looking for milk. In my experience, allowing these babies to continue to eat at this time causes them to reduce the amount they take at 7 a.m., often cutting this feeding out altogether. When this happens, I use the core-night method as follows to ensure that when the baby is ready to reduce the number of feedings he is having over a 24-hour period, it is always the middle-of-the-night feeding that he drops first.

The Core Night

The core-night method has been used for many years by maternity nurses and parents who believe in routine. It works on the principle that once a baby sleeps for one longer spell in the night, he should never again be fed during those hours in the core night. If he wakes during those hours, he should be left for a few minutes to settle himself back to sleep. If he refuses to settle, then other methods apart from feeding should be used to settle him. Hollyer and Smith recommend patting, offering a pacifier or giving a sip of water. Attention should be kept to a minimum while reassuring the baby that you are there. They claim that following this approach will, within days, have your baby sleeping at least the hours of his first core night. It also teaches the baby the most important two sleep skills: how to go to sleep and how to go back to sleep after surfacing from a non-REM (rapid eye movement) sleep.

Read the following points carefully to make sure that your baby really is capable of going for a longer spell in the night:

These methods should never be used with a very small baby or a baby who is not gaining weight. A doctor should always see a baby who is not gaining weight.

The above methods should only be used if your baby is gaining weight steadily and if you are sure that his last feeding was substantial enough to help him sleep for the longer stretch in the night.

The main sign that a baby is ready to cut down on a night feeding is a regular weight gain and reluctance to eat or tendency to eat less at 7 a.m.

The aim of using any of the previous methods is gradually to increase the length of time your baby can go from his last feeding and not to eliminate the night feeding right away.

The core-night method can be used if, over three or four nights, a baby has shown signs that he is capable of sleeping for a longer stretch.

It can be used to reduce the number of times a demand-fed baby is fed in the night and to encourage a longer stretch between feedings or after his last daytime meal.

How Giving Water in the Night Can Cause Problems

I advise that a baby between 8 and 12 weeks who is gaining at least 6 oz. of weight each week, yet still waking around 2/3 a.m., may be waking out of habit rather than hunger. In these circumstances, I suggest offering a small drink of cool boiled water. It is important that this advice be followed only if your baby takes the water and then settles back to sleep quickly for a reasonable length of time.

It is pointless to keep offering water or to persist with the core method discussed previously, if your baby refuses to settle back to sleep quickly or wakes again after only 30–40 minutes. If you continue to offer water over several nights and your baby is not settling back to sleep quickly, you will actually be encouraging your baby to sleep badly in the night—which is the opposite of what you want to happen.

If you think your baby is waking out of habit and not hunger, it is fine to offer water or some other form of comfort as described in the core-night method for a few nights to encourage him to go back to sleep. However, a baby who gets into the habit of being awake for lengthy periods in the night will soon start to get overtired during the day and want to sleep. Too much sleep during the day can also cause excessive nighttime waking. Therefore, the core method should only be used if you see a definite improvement in your baby’s sleep within a few nights.

In the long term, night feedings are easier to drop with a baby who eats quickly and settles back to sleep until the morning, than with a baby who is awake on and off and being offered water, the pacifier or cuddles to get back to sleep.

Sleepy Feeder

Sometimes a very sleepy baby may be inclined to keep dozing during feedings; but if he does not want to take the required amount, he will end up wanting to eat again in an hour or two. This is a good time to change his diaper, burp him and encourage him to finish eating. Making a little effort in the early days to keep your baby awake enough to drink the correct amount at each feeding and at the times given in the routine will in the long term be well worthwhile. Some babies will take half the feeding, have a stretch and kick for 10–15 minutes and then be happy to take the rest. The important thing that I have found with sleepy babies is not to force them to stay awake by talking too much or jiggling them about. By putting your baby on the play mat and leaving him for 10 minutes, you will probably find that he will get enough of a second wind to eat again. During the first months, allow up to 45–60 minutes for a feeding.

Obviously, if he does not eat well at a particular feeding and wakes early from his sleep, he must be fed. Do not attempt to stretch him to the next feeding, otherwise he will be so tired that the next feeding will also become another sleepy one. Top him up, treat the feeding like a night feeding and settle him back to sleep so that you can get him back on track for the evening.

Refusal of Milk

The amount of milk a six-month-old baby drinks will gradually begin to decrease as his intake of solid food increases. However, up to the age of nine months, a baby still needs a minimum of 18–20 oz. a day of breast or formula milk. This daily amount gradually reduces to a minimum of 12 oz. at one year of age. If your baby is losing interest or refusing some of his milk feeding, and taking less than the recommended amounts, careful attention should be given to the timing of solids and the type of food given.

The following guidelines will help you determine the cause of your baby refusing his milk feedings:

Up to the age of six months, a baby should still be taking 4–5 full milk feedings morning and evening. A full milk feeding consists of 7–8 oz. or a feeding from both breasts. Babies less than six months who are weaned early on the advice of a pediatrician should not be given solids in the middle of their milk feeding. They will be more likely to refuse the remainder of their formula or the second breast. Give most of the milk feeding first, then the solids.

A baby less than six months of age still needs a full milk feeding at 11 a.m., even if he is being weaned early on medical advice. Introducing breakfast too soon or offering too much solid food first thing in the morning can cause a baby to cut down too quickly or to refuse the 11 a.m. feeding.

The 11 a.m. milk feeding should be reduced and eliminated between the ages of six and seven months.

Giving lunchtime solids at 2 p.m. and evening solids at 5 p.m. is the reason many babies less than seven months cut down too quickly or refuse their 6 p.m. milk feeding. Until he is used to solids, it is better to give a baby his lunchtime solids at 11 a.m. and his evening solids after he has had a full milk feeding at 6 p.m.

Giving hard-to-digest foods such as banana or avocado at the wrong time of the day can cause a baby to cut back on the next milk feeding. Until a baby reaches seven months, it is better to serve these types of foods after the 6 p.m. feeding, rather than during the day.

Babies more than six months of age who begin to refuse milk are often being allowed too many snacks in between meals or too much juice. Try replacing juice with water and cutting out snacks in between meals.

Between 9 and 12 months, some babies begin refusing the bedtime milk feeding, which is a sign that they are ready to drop the day’s third milk feeding. If this happens, it is important to reduce the amount given at the 2:30 p.m. feeding, before eventually dropping it altogether.

Refusal of Solids

With babies of six months or older, the refusal of solids often occurs because they drink too much milk, especially if they are still feeding in the middle of the night. Every day I speak to parents of babies and toddlers who will barely touch solids, let alone eat three meals a day. In the majority of these cases, the babies are still being milk-fed on demand, some as often as two or three times in the night. While milk is still a very important food for babies at six months, failing to structure the time of milk feedings and the amounts given can seriously affect the introduction of solids. If your baby is refusing solids, the following guidelines will help you determine the cause.

The recommended age to introduce solids is at six months. If your baby is six months and sleeping through the night from 10 p.m., this late evening feeding should gradually be reduced and eliminated.

A baby is ready to be weaned when he shows signs that his appetite is no longer satisfied with 4–5 full milk feedings a day. A full milk feeding is either an 8-oz. bottle of formula or being nursed fully from both breasts. See Chapter Fifteen, Introducing Solid Food, for signs that your baby is ready for weaning.

If your baby reaches 6 months and is having more than 4–5 full milk feedings a day, drinking too much milk may be cause his refusal of solids. It is important to cut back on his 11 a.m. milk feeding to encourage him to eat more solids at that time. By the end of 6 months, a baby’s milk intake should be around 20 oz. a day, divided between three drinks a day and small amounts used in food. If your baby is still refusing solids at this age, despite cutting down on his milk intake, it is important that you discuss the problem as soon as possible with your pediatrician.

Fussy Feeder

If milk feeding is structured properly during the early days of weaning, the majority of babies will happily eat most of the foods they are offered. By the time they reach nine months, babies are expected to be getting most of their nourishment from eating three solid meals a day. Parents are advised to offer their babies a wide variety of foods to ensure they receive all the nutrients they need. However, it is often around this time that many babies start to reject food they have previously enjoyed.

If your baby is between 9 and 12 months of age and suddenly starts to reject his food or becomes fussy and fretful at mealtimes, the following guidelines should help determine the cause:

Parents often have unrealistic expectations of the amounts of food their baby should have, and serving too large portions can mislead them into thinking that their baby has a feeding problem. The following list, showing the amounts of food a baby aged between the ages of 9 and 12 months needs, will help you decide if your baby is eating enough solids.

*   3–4 servings of carbohydrate, made up of cereal, whole-grain bread, pasta or potatoes. A serving is 1 slice of bread, 1 oz. of cereal, 2 tablespoonfuls of pasta, or a small baked potato.

*   3–4 portions of fruit and vegetables, including raw vegetables. A portion is 1 small apple, pear or banana, carrot, a couple of cauliflower or broccoli florets, or 2 tablespoons of chopped green beans.

*   1 portion of animal protein or 2 of vegetable protein. A portion is 1 oz. of poultry, meat or fish or 2 oz. of lentil and beans and peas.

Self-feeding plays an important role in a baby’s mental and physical development as it encourages hand-eye coordination and increases his sense of independence. Between six and nine months of age, most babies will start to pick up their food and try to feed themselves. The whole business of feeding can become very messy, and mealtimes take much longer. Restricting a baby’s natural desire to explore his food and feed himself will only lead to frustration and, very often, refusal to be spoon-fed. Introducing lots of finger food and allowing him to eat part of his meal by himself, regardless of the mess, will make him much more inclined to take the remainder from you from a spoon.

By the time a baby reaches nine months of age, he will become more interested in the color, shape and texture of his food. A baby who is still having all the different foods mashed up together will quickly begin to get bored with even his favorite foods and this is one of the main reasons that babies lose interest in vegetables.

Offering your baby a selection of vegetables of various textures and colors at each meal in small amounts will be more appealing to him than a large amount of just one or two vegetables.

Sweet puddings and ice cream desserts served on a regular basis are major causes of babies and toddlers refusing their main course. Even babies as young as nine months can quickly discern that if they refuse the main course and fuss enough, they will more than likely be given the dessert. It is better to restrict desserts to special occasions and serve your baby fresh fruit, yogurt or cheese as a second course.

If your baby rejects a particular food, it is important that he is offered it again a couple of weeks later. Babies’ likes and dislikes regarding food fluctuate a good deal in the first year, and parents who fail to keep reintroducing food that is rejected usually find that their baby ends up eating a very restricted diet.

Giving large amounts of juice or water before a meal can result in a baby not eating very well. Offer him drinks midway between meals, not an hour before. Also, at mealtimes encourage him to eat at least half of the solids before offering him a drink of water or well-diluted juice.

The timing of meals also plays a big part in how well a baby eats. A baby who is having his breakfast solids later than 8 a.m. is unlikely to be very hungry for his lunch much before 1 p.m. Likewise, a baby who is having late-afternoon solids later than 5 p.m. may be too tired to eat well.

Giving too many snacks in between meals, especially hard-to-digest foods such as bananas or cheese, can often take the edge off a baby’s appetite. Try restricting snacks for a couple of days to see if his appetite improves at mealtimes.

If you are concerned that your baby is not consuming enough solids, it is advisable to seek advice from your pediatrician. Keeping a diary for a week that lists the times and amounts of all food and drinks consumed will help your doctor to determine the cause of your baby’s eating problems.

Common Sleeping Problems

Difficulties in Settling

If your baby is difficult to settle at nap times, it is essential that you pay particular attention to when you begin settling him and how long you spend trying to do it. The majority of babies have a hard time settling because of overtiredness or overstimulation. Once you are confident that you have your baby’s feeding and sleeping on track, I strongly advise that you help your baby learn how to settle himself to sleep. Although it will be very difficult to listen to him cry, he will quickly learn how to go to sleep by himself. He should never be left for more than 5–10 minutes before being checked. From my experience in helping hundreds of parents with babies who have had serious sleeping problems, once a baby learns how to settle himself, he becomes happier and more relaxed. Once proper daytime sleep is established, nighttime sleep will also improve.

The following guidelines should help your baby learn how to settle himself:

A baby who is allowed to fall asleep on the breast or bottle and is then put in the crib will be more likely to have disruptive nap times. When he comes into a light sleep 30–45 minutes after falling asleep, he will be less likely to settle himself back to sleep without your help. If your baby falls asleep while feeding, put him on the changing mat and rearrange his diaper. This should rouse him enough to go down in the crib somewhat awake.

Overtiredness is a major cause of babies not settling and not sleeping well during the day. A baby less than three months who is allowed to stay awake for longer than two hours at a time may become so overtired that he fights sleep for a further two hours. After three months, the majority of babies, as they get older, will manage to stay awake slightly longer, sometimes up to 2¹⁄₂ hours at a time.

Overhandling before sleep time is another major problem with young babies. Everyone wants just one little cuddle. Unfortunately, several little cuddles add up and can leave the baby fretful, overtired and difficult to settle. Your baby is not a toy. Do not feel guilty about restricting the handling in the early weeks, especially before sleep time.

Overstimulation before sleep time is another major cause of babies not settling well. Babies less than six months should be allowed a quiet winding-down time of 20 minutes before being put down to sleep. With babies more than six months, avoid games and activities that cause them to get overexcited. With all babies, regardless of age, avoid excessive talking at put-down time. Talk quietly and calmly, using the same simple phrases: “Night-night, teddy. Night-night, dolly. Sweet dreams.”

The wrong sleep association can also cause long-term sleep problems. It is essential that a baby goes down in his crib awake and learns to settle himself. For a baby who has already learned the wrong sleep associations, this problem can rarely be solved without some amount of crying. Fortunately, the majority of babies, if they are allowed, will learn to settle themselves within a few days.

Assisting-to-Sleep Method

All babies differ in how much sleep they need. During the first month some will feed, stay awake for a short period, then settle easily and sleep well until the next feeding. However, if a baby gets into a pattern of sleeping well during the day and then not settling or sleeping well in the evening or at night or is erratic with daytime naps, there are usually several reasons. Once you have ruled out genuine hunger as a cause and are ensuring that your baby is well fed, I would advise that you try a solution that I call the “assisting-to-sleep method.” The aim of this method is to get your baby used to sleeping at regular times during naps and in the evening, which will help him to sleep through the night as soon as he is physically able.

After genuine hunger and the wrong sleep associations, I find that too much daytime sleep is the most common reason why a baby does not settle in the evening or wakes frequently during the night. When this happens a vicious circle soon emerges in which the baby needs to sleep more during the day because he is not sleeping well at night. In my experience, the only way to reverse this with a small baby is to assist the baby to sleep. Once his sleep improves in the night, a baby becomes much easier to keep awake during the day, which in turn helps him to sleep better in the evening and at night.

The aim of the assisting-to-sleep method is to get your baby used to sleeping at regular times during naps and in the evening. Once your baby is used to sleeping at the same times for several days, you should find that you can settle him in his bed with the minimum of fuss.

For this method to work it is important that it is done consistently and by only one parent. During stage one of the method and for at least three days, do not attempt to put your baby in his bed at nap times or early evening. Instead, one parent should lie in a quiet room with him and cuddle him throughout the whole of the sleep time.

Ensure that he is held in the crook of your arm, rather than lying across your chest. If he is older than two months and is no longer swaddled, it may help to use your right hand to hold both his hands across his chest; in this way, he will not wave his arms around and risk getting upset. It is important that the same person is with him during the allocated sleep time and that you do not hand him back and forth or walk from room to room.

Once he is sleeping soundly for three days in a row at the recommended times, you should then progress onto the second stage and settle him in his bed. It is important to sit right next to his bed, so you can hold his hands across his chest and comfort him. On the fourth night, hold both his hands until he is asleep, and on the fifth night, hold only one of his hands across his chest until he is asleep. By the sixth night, you should find that you can put him down sleepy but awake in his bed, checking him every 2–3 minutes until he falls asleep. Do not settle him in his bed unless he has been sleeping soundly in your arms for at least three nights.

Some babies may take longer than three days to sleep consistently at the recommended times.

When he reaches stage two, at which he is settling within 10 minutes for several nights, you should try leaving him to self-settle, using the crying-down method described earlier in this chapter.

It will help your baby get used to being happy in his bed if you put him in it for short spells during the day—when he is fully awake—with a small book or toy to look at. For the lunchtime nap, if you prefer, you can take your baby out for a nap in his stroller. The important thing is to try to be consistent; the lunchtime nap should be in the stroller or in the house, but do not switch from one to the other midway through the nap.

Early-morning Waking

All babies and young children go into a light sleep between 5 a.m. and 6 a.m. Some will settle back to sleep for a further hour or so but many do not. I believe there are two things that determine whether a baby will become an earlier riser. One is the darkness of the room in which he sleeps. It would be an understatement to say I am obsessed with how dark the room should be, but I am totally convinced that it is the reason the majority of my babies quickly resettle themselves to sleep when they come into a light sleep at 5–6 a.m. Once the door is shut and the curtains drawn, it should be so dark that not even the faintest trace of toys or books can be seen. A glimpse of these things will be enough to fully waken a baby from a drowsy state and make him want to start the day.

How parents deal with early wakings during the first three months will also determine whether their baby will become a child who is an early riser. During the first few weeks, a baby who is waking and eating at 2–2:30 a.m. may wake around 6 a.m. and genuinely need to feed. However, it is essential to treat this feeding like a nighttime feeding. It should be done as quickly and quietly as possible with the use of only a small night-light and without talking or eye contact. The baby should then be settled back to sleep until 7–7:30 a.m. If possible, avoid changing the diaper as this usually wakes the baby too much.

Once the baby is sleeping and eating close to 4 a.m., waking at 6 a.m. is not usually related to hunger. This is the one and only time I would advise parents to help their baby return to sleep. At this stage, the most important thing is to get him back to sleep quickly, even if it means cuddling him and offering him a pacifier until 7 a.m. The following are guidelines that will help your baby to not become an early riser:

Avoid using a night-light or leaving the door open once you have put him down to sleep. Research shows that chemicals in the brain work differently in the dark, preparing it for sleep. Even the smallest chink of light can be enough to awaken the baby fully from his light sleep.

Kicking off the bedcovers can also cause babies less than six months to wake early. In my experience, all babies less than this age sleep better if tucked in securely. The sheet needs to be placed lengthways across the width of the crib to ensure that a minimum of 8 inches is tucked in at the far side and a minimum of 4 inches at the near side. I advise rolling up a small hand towel and pushing it down between the slats and the mattress on the near side to further secure the sheet.

Babies who work their way up the crib and get out of the covers will benefit from being put in a lightweight 100 percent cotton sleeping bag and tucked in with a sheet as described above. Depending upon the weather, blankets may not be necessary.

Once a baby starts to move around the crib and is capable of rolling, I advise that you remove the sheets and blankets and use only the sleeping bag. This will allow your baby to move around unrestricted, without the worry that he might get cold in the middle of the night. It is important to choose a sleeping bag that is suitable for the time of year.

Do not drop the late feeding until your baby has reached six months and has started solids. If he goes through a growth spurt before he starts solids, he can be offered extra milk at this time. This reduces the chances of waking early due to hunger.

A baby who is more than six months old and has dropped the late feeding should be encouraged to stay awake until 7 p.m. If he is falling into a deep sleep before this time, he will be much more likely to wake before 7 a.m.

Excessive Night Waking

Until the mother’s milk comes in, a newborn baby may wake and need to be fed several times a night. By the end of the first week, a baby who weighs more than 7 lbs. should manage to sleep for a stretch of 4 hours from the 10–11 p.m. feeding, provided he is getting the amount of milk he needs during the day. Smaller babies may still need to feed every three hours around the clock. In my experience, all babies who are healthy and well fed will, between 4 and 6 weeks of age, manage to sleep for one longer spell of 5–6 hours. By following my routines, this longer spell should happen in the night.

How long a baby will continue to wake for a feeding in the night depends very much on the individual baby. Some babies between six and eight weeks old sleep through after the late feeding; others reach this milestone between 10 and 12 weeks. Some take even longer. All babies will sleep through the night as soon as they are physically and mentally able, provided the daytime feeding and sleeping is being properly structured. The following list shows the main causes of excessive nighttime waking in healthy babies less than one year old:

Sleeping too much during the day. Even very small babies need to be awake some of the time. The baby should be encouraged to stay awake for 1–1¹⁄₂ hours after daytime feedings. Between six and eight weeks, most babies are capable of staying awake for up to two hours.

Not feeding enough during the day. If excessive night feeding is to be avoided, the baby needs to have six feedings between 7 a.m. and 11 p.m. To fit in this number of feedings, the day must start at 7 a.m.

Not feeding enough at each feeding. In the early days most babies need a minimum of 25 minutes on the first breast and after this should be offered the second breast.

Breast-fed babies will be more likely to wake several times a night if they do not get enough to eat at the late feeding; they may need a top-up.

Babies less than six weeks have a very strong Moro reflex (see Chapter Four, Understanding Your Baby’s Sleep) and can wake themselves several times a night by the sudden startle and jerk. In addition to being securely tucked in with an appropriate weight of sheet and blanket, these babies will benefit from being swaddled in a lightweight stretch-cotton sheet.

Older babies often wake several times at night because they have kicked off their covers and are cold, or they may their legs may have been caught between the slats of the crib. A sleeping bag will help them avoid both problems.

The baby has learned the wrong sleep associations. Between two and three months, his sleep cycle changes, and he will come into a light sleep several times at night. If the baby is used to being fed, rocked or given a pacifier to get to sleep, he will need the same assistance to resettle himself in the night.

Babies older than six months are more likely to be woken several times a night by the nursery door left open or a nightlight left on.

If the baby’s milk feedings are reduced too quickly when solids are introduced, he will begin to wake in the night genuinely needing a milk feeding.

Sleepy Late Feeding Causes Excessive Night or Early-Morning Waking

In the early days, establishing a full feeding in the late evening will help enormously in getting your baby to sleep for his longer spell during the night. Earlier in the book, I advise that this feeding should be a quiet one in the nursery, so that the baby does not become overstimulated and then refuse to settle well. However, if your baby is so sleepy that he is not taking enough milk to get him to go one longer stretch in the night, then I suggest that you introduce a split feeding (see Chapter Six, Weeks One to Two). The success of the split feeding depends upon the baby being awake slightly longer and drinking more milk.

Some of the babies that I cared for were so sleepy in the early days that I would have to start waking them at 9:40/9:45 p.m. I would begin by switching on the light low, pulling back the covers, taking the baby’s legs out of his sleep suit and then leaving him in his crib. I would allow 10 minutes, and if he was not starting to stir, I would then turn the light a little brighter. Regardless of how asleep he was, I would take him out of the room by 10 p.m. at the latest. I would take him either to my bedroom or the sitting room, where I would have the lights and possibly the television switched on to create a more stimulating environment. I would then lay him on his play mat for a further 5–10 minutes if he was still not completely awake before I offered him the first bottle of his split feeding.

I would ensure that I made the formula slightly warmer than normal and would always prepare a fresh bottle for the second half of the split feeding, which I would give at 11:15 p.m. I would keep the baby as awake as possible between 10 and 11 p.m. With some babies, it would often take up to two weeks to establish this split feeding; but once it was established it really did help them take a bigger feeding and sleep longer in the night.

If you are breast-feeding, the same method can be used, only you offer one breast at 10 p.m., followed by the second breast at 11:15 p.m. Some babies may actually need both breasts at 10 p.m., and then be offered the second breast again at 11:15 p.m.—or perhaps a top-up of expressed milk if you feel your milk supply is low at this time.

If your baby is less than 12 weeks, very sleepy and not feeding well at the last feeding, it really is worth persevering with trying to establish a split feeding. For this to work at the late feeding, you would also have to be doing a split feeding at 5/6:15 p.m. If you drop the split feeding at this time, your baby will probably be taking a much bigger feeding after his bath, which would have the domino effect of reducing his appetite at the late feeding. In order for the late split feeding to work, you need to continue with the split feeding at 5/6:15 p.m.

If you have tried all of the suggestions and your baby is still not eating well and is waking early in the night, you may wish to try dropping the 10 p.m. feeding for several nights and seeing how long he goes naturally. Once your baby sleeps a longer spell for several nights in a row, you would then reintroduce the 10 p.m. feeding and, hopefully, the baby will continue to sleep this longer spell at the right time of night.

The majority of babies will continue to need at least one feeding in the twelve-hour night until weaning is well established at around seven months of age. Therefore, it really is worthwhile being consistent and persistent about establishing a 10 p.m. feeding.

Illness—The Effect on Sleep

The majority of my first babies manage to get through the first year without suffering the colds and coughs that seem to plague my second and third babies. By the time most first babies experience a cold, their sleep is so well established that waking in the night is very rare. With second and third babies, this is not the case as they usually catch their first cold at a much younger age from a brother or sister, and disrupted nights are inevitable. A baby less than three months old will usually need help to get through the night when he has a cold or is ill. A young baby with a cold can get very distressed, especially when he is trying to drink his milk, as he will not have learned to breathe through his mouth.

When a sick baby needs attention in the evening and during the night, it should be given calmly and quietly. A sick baby needs more rest than a healthy baby. Lots of visitors and activity in the area where the baby sleeps during the evening and in the night should be avoided. When I have had to care for a sick baby of more than six months who wakes several times at night, I find it less disruptive if I sleep in the same room as the baby. It enables me to attend to him quickly and I am less likely to interrupt the sleep of elder siblings by coming and going along the corridor.

Occasionally, I find that an older baby who has dropped nighttime feedings will, once he has recovered, continue to wake in the night looking for the same attention he received when he was unwell. For the first few nights I would check him and offer him some cool boiled water, but once I was convinced he was completely recovered, I would leave him time to settle himself. In my experience, parents who are not prepared to do this usually end up with a baby who develops a long-term sleep problem.

If your baby develops a cold or cough, regardless of how mild it appears, he should be seen by a doctor. All too often I hear from distressed parents of babies with serious chest infections that might have been avoided if a doctor had seen them earlier. Too many mothers delay taking their baby to a doctor, worried that they will be labeled as neurotic, but it is important that you discuss with your doctor any concerns you have about your baby’s health, however small. If your baby is ill, it is essential that you follow your doctor’s advice to the letter, especially on feeding.

The Lunchtime Nap

The lunchtime nap is a fundamental part of my CLB routines. Research shows that babies and young children benefit from a proper, structured nap in the middle of the day. As your baby grows and is more active, this nap will become his time to rest and recover from the morning’s activities and will enable him to enjoy his afternoons with you and others.

However, I am well aware that in the early days a lunchtime nap can sometimes go wrong. I understand the feelings of frustration when a baby wakes 30–45 minutes into the nap and, despite still being tired, refuses to settle back to sleep. Assuming that the wrong sleep associations have not been established, there are several things you can do to improve the lunchtime nap.

First, allow your baby a short time to settle himself back to sleep, provided you are confident that the waking is not due to genuine hunger. Normally, over a period of a week or so, if a baby is allowed 5–10 minutes of crying down, he will then start to settle himself back to sleep. Obviously, if you find that after 10 minutes your baby is not crying less, but is in fact crying harder, then he should be attended to. With a baby who is crying harder, I would offer half of the 2 p.m. feeding, treating it like a night feeding, so that the baby does not become overstimulated by lots of talking or eye contact. I would then assume that the reason why the baby can’t settle himself back to sleep is because his coming into a light sleep coincides with his starting to get hungry.

Hunger—Young Babies

To eliminate the possibility of hunger causing a disturbed lunchtime nap in very young babies, I would bring forward the morning feeding to 10/10:30 a.m., and then offer a top-up just before they go down for their nap. This way you can be confident about allowing them a short crying-down period, without worrying that they might be hungry.

If your baby continues to cry and fails to settle back to sleep, it is worth considering the amount of sleep he is getting at the morning nap.

Morning Nap—Younger Babies

If your baby is between one and six months old and sleeping for more than one hour in the morning, it could be that too much morning sleep is affecting his lunchtime nap. Depending upon how much sleep your baby is getting at the morning nap, I would try reducing it to between 45 and 60 minutes, maximum. Occasionally, with some babies more than three months old I have had to reduce the morning nap to only 30 minutes to ensure a two-hour nap at lunchtime.

If you find that you cannot push your baby as early as 9 a.m. for his morning nap, I suggest that you do a split morning nap for a short time in order to reduce his overall morning sleep time.

Allow him 15/20 minutes at the first part of the split nap, then a further 15/20 minutes at the second part of the split nap.

By offering your baby a top-up before his lunchtime nap, reducing his morning nap to between 30 and 40 minutes and allowing him a short spell of crying down when he does wake after only 45 minutes, he should start to sleep for a longer spell again.

Hunger—Older Babies

With a baby who is weaned, you can try offering a top-up of milk just before his lunchtime nap. If you find that he is taking quite a large top-up, it would be worth considering the amount of solids that you are giving and ensure that you are getting the right balance of protein, carbohydrates and vegetables.

By seven months, your baby should be eating three meals a day and solids should be well established. If you have weaned at six months, you will need to move through the guide quickly to build up the right amounts of food.

If your baby is more than nine months old and is not having a good drink of water or well-diluted juice with his lunch, thirst can be a reason why he wakes early from his nap, especially during hot weather. It is, therefore, worth offering him a drink of water just before his lunchtime nap.

Once the possibility of hunger is ruled out, if your older baby’s crying continues to escalate rather than diminish, then you should consider the amount of sleep he is getting in the morning.

Morning Nap—Older Babies

With babies more than six months old, try to ensure that the morning nap is not before 9:15/9:30 a.m. If you find your baby is sleeping longer than 45 minutes at this nap, this could be the reason why he is not sleeping long enough at lunchtime.

If your baby is between six and nine months old, reduce the morning nap gradually, cutting it back by 10 minutes every three or four days until it is down to 20–25 minutes. If your baby is between 9 and 12 months old, try reducing it to 10–15 minutes or cutting it out entirely. You may find that for a short time, if the baby is getting tired, you will have to make his lunch and nap a little earlier.

The top-up before the nap and the reduction in the morning sleep should see an improvement in the length of time he sleeps during the lunchtime nap within one or two weeks.

The Lunchtime Nap—Further Troubleshooting

If you find that your baby will not resettle back to sleep at the lunchtime nap, despite trying all of the previous suggestions, you will have to adjust his afternoon sleep routine, so that he does not become overtired at bedtime. The age of your baby will dictate how much sleep you give him later in the day.

A baby of 6–9 months may need a 30-minute nap after the 2:30 p.m. feeding and then a further short nap at around 4:30 p.m. This should stop him from getting overtired and irritable and will help you to get his routine back on track again by 5 p.m., so that he settles well at 7 p.m. Sometimes a baby doesn’t sleep at 2:30 p.m., especially if more than nine months old, but will then fall asleep later, between 3–4 p.m., and then wake after 30–45 minutes. If this happens, you may find that you have to bring bedtime forward slightly.

The important thing to remember when adjusting the routines to make up for a shorter lunchtime nap is to try to follow the recommendations for the maximum amount of daily sleep for your baby’s age. Also, try to make sure that your baby is up and awake by 5 p.m. if you want him to go down well at 7 p.m.

CHECKLIST

Rule out hunger as the possible cause of waking by offering a top-up milk feeding just before the nap. If an older baby who is weaned is drinking more than a couple of ounces, it is possible he needs his solids to be increased. Some breast-fed babies, despite eating a good amount of solids, may need a top-up breast-feeding until past nine months of age.

With an older baby, check to see if he is thirsty by offering him a drink of cool boiled water just before he goes down for his lunchtime nap.

Correct any poor sleep associations, such as falling asleep on the breast or the bottle, and ensure that he goes down well fed in his bed. It might take some time to get your baby into good habits, so you will need to be patient.

Eliminate all other reasons for waking, such as excessive noise or loose bedsheets. (Remember that the Moro reflex—see Chapter Four, Understanding Your Baby’s Sleep—can be very strong in babies less than six months, so tucking them in securely is very important if they are not to wake themselves up.)

Always allow your baby to wake naturally and, after the first few weeks, provided he is not screaming for food, allow him a short awake spell in his bed before you pick him up; in this way, he will not associate waking with being picked up.

If the lunchtime nap still continues to be a problem (and you feel your baby has gotten into the habit of waking when he comes into a light sleep), you have checked everything on the checklist and given any changes enough time to work, it may be worth trying the assisting-to-sleep method mentioned earlier in this chapter. This method can help babies to sleep at regular times, not just at night.

Crying Down During the Lunchtime Nap

In my books, I say that crying down can be used from a very young age with babies who fight sleep or are overtired. It is very important to understand the difference between crying down and sleep training so that your baby is not caused any distress and the problem you are struggling with is not made worse. The following is a brief summary of the method:

Crying down is appropriate when a baby who is well fed, tired and ready to sleep but fights sleep when put into the crib. He will usually cry on and off for 5–10 minutes before drifting off to sleep—although some very overtired babies may cry on and off for up to 20 minutes. Once asleep, these babies will then sleep for the full nap time or at night until the next feeding is due.

If your baby wakes after 30–45 minutes and then settles back within 10–20 minutes of fussing for a further 30–45 minutes, this could be classed as crying down. But if your baby wakes after 30–45 minutes, does not settle back to sleep and is left to cry for longer than the suggested time, then this is not crying down.

I do not recommend that babies be left to cry for lengthy periods. It causes distress and creates a habit of them crying the minute they wake or come into a light sleep. It is much better to get the baby up and allow him one or two short naps later in the afternoon, depending upon his age. In my experience, as long as parents establish the right sleep associations and learn how to adjust the afternoon nap so that their baby does not become overtired, their baby will eventually start to sleep longer during the lunchtime nap.

Sleep Associations

During the early months, many babies are happy to doze on and off in a car seat or baby carrier, which can be convenient as it allows parents more flexibility. Unfortunately, once a baby becomes bigger and more active, he is unlikely to continue to sleep well or for long enough in either one of these (and probably will have outgrown the baby carrier and bassinet by then). If this habit is established, it can be very difficult to get him to sleep in his crib during the day. The sleep in the car seat is unlikely to be satisfying, and as he gets older, he will most likely spend the time catnapping and become tired and irritable later on. As a result, he might not eat well at the late-afternoon snack or will fall asleep before he’s had all of his bedtime milk. Night wakings due to hunger can then result, leaving all of you tired the next day and so the problem continues to get worse. You need to start putting him to sleep in his bed as early as possible. If you can’t because of older children or other responsibilities, settle the baby in his stroller in a quieter part of the house so he has a better chance of sleeping undisturbed.

If poor sleep associations have taken root, you will need to focus on getting him to sleep during this nap period whatever it takes. This is known as the assisting-to-sleep method (see earlier in this section). Take him out in the stroller or the car and let him have the two hours he needs. I usually found that if I did this for a week or even 10 days, the baby’s sleep cycle would adapt to it, and it was easier then to put him down in his crib with just a little bit of crying down.

Teething and Night Waking

In my experience, teething rarely bothers babies who enjoy a routine from a very early age and have established healthy sleeping habits. Out of the 300 babies I have helped care for, only a handful have been bothered by teething in the night. In these cases, it is usually when the molars come through and then only for a few nights. I have found that babies who wake in the night due to teething are more likely to have suffered from colic and have developed poor sleeping habits.

If your baby is teething and waking in the night but quickly settles back to sleep when given a cuddle or a pacifier, teething is probably not the real cause of his waking. A baby who is genuinely bothered by teething pain would be difficult to settle back to sleep. He would also show signs of discomfort during the day, not just at night. I advise you to check the section on excessive night waking and early-morning waking to eliminate other reasons for your baby waking.

If you are convinced that your baby’s nighttime wakings are caused by severe teething pain, I suggest you seek advice from your doctor regarding the use of medicine. While genuine teething pain may cause a few disruptive nights, it should never last for several weeks. If your baby seems out of sorts, develops a fever and suffers from loss of appetite or diarrhea, a doctor should see him. Do not assume that these symptoms are just signs of teething. Very often I have found that what parents thought was teething turned out to be an ear or throat infection.

Golden Rules

Finally, here are some essential tips to avoid potential problems in the first year:

In the early days I advise that babies can stay awake for up to two hours. This does not mean that they should be awake for two hours. If your baby settles to sleep well in the evening and after night feedings but can only stay awake for an hour or so at a time during the day, he is obviously a baby who needs more sleep. However, if your baby is not settling well in the evening or after feedings in the middle of the night and you have ruled out the possibility of hunger, then it would be worth gradually lengthening your baby’s awake time by a couple of minutes every few days until he can stay awake happily for longer and sleep better during the night.

I recommend that babies should be allowed up to 25 minutes on the first breast, not that they must have 25 minutes on the breast. Some babies are very efficient eaters and can take a full feeding in much less time. If your baby is gaining weight and settling to sleep well for daytime naps and at night, then you do not need to worry about how long he is on the breast. However, if your baby is unhappy between feedings and not settling well for naps, it’s possible that he is not taking a full feeding. Try offering him the breast just before naps. If he then settles well, you can be fairly sure that hunger is the cause of him not settling. To remedy this I would advise seeking help from a lactation consultant to ensure that you are latching your baby onto the breast properly. Once you are confident about this, you should keep checking that he is actually swallowing and not just sucking when he is feeding. Very small babies who spend lots of time sucking instead of feeding can quickly become tired and pull off the breast before they have taken a full feeding.

If your baby is crying in the early days, you should always assume he is hungry and feed him. Remember, when I talk about every three hours, the three hours are calculated from the beginning of one feeding to the beginning of the next feeding. This means there is really only a two-hour gap between feedings. I also say that, if a baby is genuinely hungry before the recommended feeding times, he should always be fed. However, if your baby is looking for a meal long before the recommended time for his age, you should also try to work out why. The cause with breast-fed babies is usually a low milk supply or the baby not taking enough while nursing. If your baby is formula-fed and not managing to go three hours between feedings, you should consult your pediatrician.

Do not move on to the next routine until your baby shows signs that he is ready to stay awake longer and go longer between feedings. Depending upon your baby’s individual needs, you may find that he is sometimes between two routines. This may result in following sleeping times from one routine and feeding times from the next, or vice versa, but this is fine.

Remember, the aim of the routines is to establish healthy long-term sleeping and feeding habits. A baby will sleep through the night as soon as he is physically and mentally able. You should not try to push your baby through the night by restricting or reducing night feedings too quickly.

To avoid early-morning waking, ensure that in the first few weeks when your baby wakes in the night, you feed him enough to satisfy him until close to 7 a.m. In addition, once he is sleeping to 5/6 a.m. you should not leave him for lengthy periods to see if he will settle back to sleep. A baby who gets into the habit of being awake for any length of time between 5 a.m. and 7 a.m. is much more likely to develop a long-term early-morning waking problem than a baby who is fed quickly and settled back to sleep.

It is also important that you do not reduce the time your baby is awake at the late feeding until he is sleeping regularly until 7 a.m. If he reaches three months of age and is not sleeping until close to 7 a.m., it is worth splitting the late feeding and having him awake longer at that time. In my experience, the split feeding nearly always helps very young babies sleep longer into the night; with older babies who were waking at 5 a.m., it helps them to stay asleep until closer to 7 a.m. Refer to Chapter Six, Weeks One and Two, for details on how to implement the split feeding, and allow at least a week to establish it. The key to the success of the split feeding is ensuring that you wake the baby no later than 9:45 p.m. and keep him fully awake for the recommended time.

Babies more than six months old who have dropped the late feeding and start to wake between 5 and 6 a.m. but do not settle back to sleep within 10 to 15 minutes should be offered a breast or bottle, even if the cause is not hunger. In my experience feeding the baby is the quickest way to avoid long-term early-morning waking. At the age when solids are established, too much daytime sleep is usually the cause of early-morning waking. Trying to reduce daytime sleep with a baby who is waking early is very difficult, hence the reason for offering a feeding as, unlike offering a pacifier or cuddles, it allows the baby to settle himself back to sleep. Then, as the baby sleeps better between 5 a.m. and 7 a.m., gradually push the 9 a.m. nap on to 9:30 a.m. and reduce it to 30 minutes. This will then enable you to push the lunchtime nap on to 12:30 p.m. and will eliminate any late-afternoon nap. Once your baby’s daytime sleep is reduced you will probably find that he will naturally start to remain asleep until closer to 7 a.m. and will drop the early-morning feeding. However, if he has been sleeping through to close to 7 a.m. for at least two weeks and you find that you are still feeding him between 5 a.m. and 6 a.m., you can start to reduce the amount of milk you give him. Once you reach a stage where he is settling back with only the smallest amount, you can then drop the feeding and allow him to settle himself back to sleep.