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To: Getting a baby to sleep

Many friends have asked me to post on my tips to get a baby to sleep.  I have followed the same guidelines for all my babies and they begin sleeping 12 hours a night at around 12 weeks old.  That's right, a solid 12 hours without waking me up!  I will post as if I just had my baby yesterday.  I always tell moms if they are having sleep problems to revert back to the very basics, as if they just brought their baby back home, no matter the age. And follow these steps to make sure they are being met.  Many times this corrects the problem.

Also, this post is not for controversy, simply sharing what has worked for me to help others.  Another thought, I do not share the bed with my babies.  One of my number one desires is to get the baby to sleep through the night.  I am a much happier human being when I get my sleep.  Having a baby in bed for one would not let me sleep (I have a hard enough time sharing my bed with my husband, haha) and secondly, I don't want me or my bed to be my babies sleep prop that we have to wean.  I do how ever keep my babies close (co-sleeper- a 3 walled pack n play that scoots up to my bed) or in my room or closet for a while (this last baby till she was 6 months old, bless her ;)).

First month or more: 
- Full feeds!  No snacking.  Get a newborn to have a full feed.  This will look different for every baby according to their needs and the way they are being fed.  A full term, premie, bottle fed, breastfed, big or small baby, etc. they all will take a different amounts and feed more or less according to the situation.  But, establish what a full feed is.  Look for their cues- content, tired, open fists (a hungry baby will have closed fists and they will open as they become full and content), sleeping, etc.

After the baby is a bit more established at home (couple of weeks, give or take) you can tell if they are getting a full feed by their establishing feed, wake, sleep pattern.  For example, if my baby was on a 3-ish hour schedule: I feed at 6 AM and she falls asleep after a feed.  She should stay asleep until about 9.  If the baby is waking back up at 7 AM, she probably did not get a full feed and pre-maturely fell asleep because she was cozy and happy sucking, not completely full.  As a consistent pattern begins to emerge, you know the baby is being well feed.  If the sleep patterns are not consistent between most feeds, then work on fuller feeds (supply up if breastfeeding; breastfeed and top off with bottle; or more formula or breast milk in bottle).

I am not addressing every single feed, but see the pattern.  A baby could be fussy, grow spurt, cluster feeding, etc., but look for a general pattern of what the baby is doing.  A new baby is typically on a 2-4 hour schedule, depending on their needs.  Can the baby "stick" to that "designated" schedule?  And this is a flexible schedule, and really not even a schedule, but more of a gauge to see if they are getting full feeds.  Is my baby sticking to a routine (roughly), as the example down below (and my routines are more on a 30 minute range from the designated time?  I don't run my baby from the clock, per-say.  If so, great, you are ready for step two.

Now- some babies aren't really into eating and won't wake to feed.  Then- you wake to feed them!  I think it is ridiculous when people say never wake a sleeping baby.  My thoughts are why?- so they can wake you up all night to feed?!  No way, not in my house.  I wake them up throughout the day to fill them up.  Say a baby needs 24 oz in a 24 hour period.  It doesn't matter when they get this amt., as long as they are getting their food.  So- in my house, we wake our babies to feed them.

Typically I need to wake my babies until they are around 4 months old to feed them (not including nights).  And this is not for all feeds, but around 4 months, at least with my last baby, she was finally waking for all her day feeds without my prompting.

So this is an example of a baby's schedule 0-1 month old:

6 am: feed #1
6:50 nap
9 am: feed #2
9:50: nap
12 pm: feed #3
1pm: nap
3 pm: feed #4
4 pm: nap
6pm: feed #5
6:30: bath/bedtime routine
7 pm: feed/bed #6
10 pm: feed #7
2 am: feed #8

At night time, as long as they are gaining weight and doctor says they okay, I let my babies sleep and wake me up when they are ready to eat.  By letting them wake you up you allow them to practice their long periods of sleeping at night, obviously.  And when you are waking them up during the day to feed, you know you are getting in enough feeds.

Also, with a full feed, it helps establish good naps during the day.  The more practice they can get sleeping for long periods during the day, the more practice they have for night time.  When a baby is not getting a full feed, they are also not getting a full nap.  And when they aren't practice good long naps, they aren't used to long periods of sleeping at night.

Sleep begets sleep!

Once full feeds are established, move onto: a Feed, Wake, Sleep pattern:
Once your baby is taking full feeds, establish keeping your baby up after their feed. For a newborn baby this is basically enough to feed them and change their diaper, and possibly a quick 5 minutes hello.  But, for starters, this is enough.  As the baby gets older, their wake time will increase, but it takes time.  Such as my 7 month old can only really stay away for 2.5-3 hours long.  That's not a very long time.  So for an newbie, they are asleep most of the time.

During the newborn wake times (eating basically), do this in the day light, not in a dark room.  You can also nap them (at the beginning) in the light (not a dark quiet room), to help them establish their days and nights.

So this schedule does not look like this: feed them, let them sleep on you for half the feed and then wake them and then put them to bed.  It also does not look like this: feed them, they are so cute after the feed you let them take a cute little cuddly nap on you for 10 minutes and then you wake them and then put them back to sleep.

This is what it looks like: baby wakes up to feed.  Keep them awake to take a full feed (yes, I know this is difficult, I've had 2 NICU premie babies).  Change their diaper.  Look for their sleep cues, let them fall asleep.  So yes, Feed them, let them be awake.  Let them sleep.

Natural sleep vs. artificial sleep.  Put your baby down when they are naturally tired, not artificially tired.  Just woke up 15 minutes ago, but they are cozy drinking their bottle and fall back asleep?  That is artificial sleep.  Their nap won't be long and you'll get in a cycle of cat napping, never getting predictable, long naps.  Put your baby down after he has been awake for his sufficient wake time length.

And there are times of course where this routine is not met, life happens and we want to spoil ourselves.  But, in a general case, feed, wake, sleep cycle should be happening.

If the baby wakes up sooner than his "designated" time (say he usually goes 2.5 hours between every feed, but he woke up at 1.5 hours), work with him to fall back asleep.  But, if he doesn't want to go back to sleep, feed him.  And that feed, wake, sleep cycle will just continue starting from that time.

I love the feed, wake, sleep cycle because it is following the babies cues, but also establishing a routine. For example: say you let the baby snack.  Then the baby gets fussy, it leaves the parent wondering if their baby is tired, hungry, gassy, etc.  But, if a baby has had a full feed and been awake, the baby is not hungry, could be gassy, but probably tired.  When the baby falls asleep and then wakes up, we know what to do- feed them.  People say, the baby knows what they want.  No they don't (well, yes, they do.  They're reflexes are wonderful: eating, rooting, moro, etc.), but, just as a toddler needs, establishing a routine helps the baby to relax and be happy as their circadian rhythm and body clock begin to "know" what's next and what to do (when to sleep!).

Also, a feed, wake, sleep cycle helps a baby learn to fall asleep without feeding.  Again, the day time is practice for the night time.  We are learning how to get a baby to fall asleep for long periods at night, right?  So, the feed, wake, sleep routine sets a baby up to falling asleep being cuddled, or whatever the method (I can post another night on bed time routines and the dos and don'ts), but without the comfort of a feed.  Wouldn't you rather let the baby smooth themselves back to bed, or going in a patting them, rather than constantly having to feed them to comfort them back to bed?  Me, please! (And of course, this is when the baby is sleeping through the night and not waking because they are hungry).

Wake times amount/lengths.  A wake time is what it sounds like, the amount of time a baby is awake.  If you are following the feed, wake, sleep cycle, then a wake time is easily "chartable".  That is because your baby is not taking cat naps, he is taking full naps.  So, when a baby wakes, until his next nap, that is considered his wake time length or amount of time his body can happily be awake before it needs to go back to bed.  Such as: my baby wakes at 7 am and falls back asleep at 8:15 am.  I know that my babies wake time length is 1 hour and 15 minutes.  By knowing your babies wake time amount (will change really every couple of weeks), you will know how and when to establish his routine.  A babies wake time lenght will be approximately the same for every "wake time" they have throughout the day.  By knowing the babies wake time lenght, you are also able to know when to look for their sleeping cues, so you can start their sleep routine at the first sign of sleepiness, so they can take a good restful nap. Seeing a baby cry because they are tired is the last sign they have shown you that they are tired.

So to recap.  By giving baby a full feed, we are able to see that the baby is taking full naps until their next feed.  Also, by knowing their wake time length, we know when to put them down for a nap.

Decide when naps end:
If you need the child to wake and eat at a certain time to maintain a daytime or night time routine, wake them up.  This is an example: If a baby is taking a nap and if it is 6pm and I want to put my baby to bed at 8pm, I would need to wake him up and feed him so he would be hungry and tired again by 8pm (know this by knowing his wake time amount). 

Also, babies love to sleep during the day and eat at night- at least if you let them.  I am aware at how many feeds a day they should be having by knowing what schedule they are on (3 hour, ect.).  I wake my babies up to feed them at the appropriate times so they get all their feeds in during the day and don’t have to do so many at night.  …. Say a baby needs 32 oz in a 24 hour period.  Does it matter if they get most or all of that 32 oz during the day vs. at night?  No.  

Nap time is practice for nights: 
Pretty much right away I begin practicing for night, during nap times.  This is what nap time looks like in our home:
- Know Wake time Amount: I know baby's wake time amount.  Around the time that designated time is up I begin watching for the baby's signs to sleep: fidgety, yawn, rub eyes, rub head to side, fussier, don't make eye contact, etc.  The first sign, I try to respond.
- Swaddle: Wrap baby up in swaddle.  - yeah, I know your baby doesn't like the swaddle, is that what you're saying?  Does your baby have problems sleeping?  Well, they've been wrapped up for 9 months and are used to it.  Their nervous system is not used to "freedom", wrap them up! Also, starting to wrap them from the very beginning helps train them to be swaddled so they'll sleep better.
- Dark Room: Dark room once their days and nights are figured out.  The naps are longer during the night than during the day.  Such as, a newborn will be happy to sleep for 5 hours during the day, but won't do that at night. - yes, their nights and days are not yet figured out.  When that switches, then begin napping them in the dark for nap times to establish routine and help them take full naps.
- 5 S's: use the 5 S's: swaddle, suck (binky/finger), side/stomach, sway/pat, "shh"/white noise. So we swaddle our baby and put them on our chest (later sitting in our lap on their side against our chest), pat their back, put on white noise, and let them suck on their binky.  (I love "Happiest Baby on the Block" by Harvey Karp)
- Hold:  I try not to do too much movement.  Patting is enough.  I don't want to become their sleep prop.  I want my babies to get used to being still.  And of course, this is once they are calm.
- Put in Bed, Not Asleep: when the baby begins get that glazed look/starting to close eyes, I put them in their bed.
- Pat, if needed: If they fidget in their bed and need me, I pat them. Get them used to falling asleep in their crib, not always being held.
- Know their sounds:  Also, get to know your babies sounds.  They have grunty sounds, fussy, whinny, cry, scream, etc.  I am not saying let your baby scream while you go up stairs and completely block them out.  But let them figure out themselves and you pay attention too.  Like when they are getting their diaper changed.  Great place to learn and usually doesn't bother parents as bad because there's not much you can do.  Many times that turns into a mad cry, right? Higher pitch, very airy, they get out of breath and have to take large pauses to breath.  Or can you picture in your mind a whine cry?  It is softer and more sing song-y.  A fuss cry is more rhythmic and doesn't fluctuate much in intensity.  When you put your baby down for a nap, sometimes they establish their own sounds to calm themselves.  I've had parents say their baby needed to scream cry to 10 minutes and then he would be out.  If they interrupted that he would never take a great nap. Others whine cry themselves to sleep.  My 7 months old has begun making a talk/humming sound before she falls asleep. Trying to disrupt this from occurring prevents the baby from learning how to find their "happy place" to sleep.
- with the last comment, I work my baby to going to bed more and more awake.  All newborns are different.  My second rathered to be put in his crib and patted to drift off.  My third likes to be held more and be more asleep than awake and then be put down.  But, usually the sooner you begin this as a newborn, the easier it is.  It is all about what they are used to.  For me, I'd rather my newborn get used to what I want them to be doing in a few months, then struggling in a few months re-training them what I want them to do.
- Also, babies stages change and their needs to go down change too.  A newborn does not need it to be dark and quiet.  They will fall asleep fast.  Verses an older baby needs a routine that stays the same- swaddled, dark room, white noise, put down before they get their second wind (wake time known amount, so important!).
- Put Down and Leave Room: Once I put them down, I leave the room.  I don't have to "sneak" out of the room, because they're not dependent on me to completely fall asleep. I have a video monitor to watch them when I have questions about their status during their nap.
- During Nap Issues: getting them to sleep for the length of time until their next feed is the first priority.  So say the baby wakes up but has another hour to sleep until usually feeds.  You've assessed them and know they're not hungry, then work on getting them to fall back asleep.  Pat and binky, don't take them out of their crib, first.  If that isn't working, hold and do bedtime routine to fall asleep (re-swaddle if needed; binky; pat/swing) and then put down and pat.  If that isn't working, swing? or another way they like to sleep.  Using swings, car seats, etc. to use as a sleep prop isn't loved by parents, usually, but a full nap trumps all.  Many times those sleep props naturally wean as the baby gets older or you can work on the weaning process.

Such as my first loved waking up in the middle of his naps.  I don't think I was great at letting him "figure things out", either (first time mom, you know), but he loved to wake and be in his swing or vibrator.  His "45 minute intruder" (talk about that another post) was strong.  My last loved her car seat for the first 3 months to nap.  She wouldn't really nap any where else.  I hated this, but accepted that I'd rather her nap than not.  At 3 months she only wanted her crib and didn't like sleeping in her car seat.  - so, listen to your baby.  But sleep trumps even sleep props (including you having to hold them to fall back asleep or sleep on you for the rest of the nap).

Say the baby isn't falling back asleep and has completely woken up, or, this baby is not your only one and you don't have time to spend time helping them?  Then they are awake and it is time to feed them.  Then feed them and begin the feed, wake, sleep cycle from that point.  If the baby has only taken a 30 or so minute nap and it clearly isn't time for the baby to eat (and for that matter they wouldn't take a full feed because they aren't hungry), wait and feed them when they get hungry.  Do not make a habit of this-  this would be a feed, wake, sleep, wake, feed cycle.  It gets confusing.  So make a habit of feed, wake, sleep.

Morning and bedtime is always at the same time: (except for those needed date nights)
The babies biological clock sets and they know when to go to bed at night and when to wake up in the morning.  Just like us as adults.  This helps them sleep through the night faster. 

So to help set their biological clocks see when they want to naturally go to bed (usually earlier the better, 6pm, 6:30pm, 7pm-8/8:30pm).  When you identify when they want to go to bed, about a half an hour before he wants to fall asleep, start the bedtime routine.  That way he is not screaming through the bath because he is hungry and he is not getting over tired. Also, waking them up at the same time every morning is so important.  See next section.

Set Morning wake time: once you are out of the just got home from the hospital fog, set a time where you'll always wake the baby in the morning.  Most of the time this naturally evolves or you can also go according to about 12 hours from the time you put the baby down from bed time.  Like us adults, if we have good sleep hygiene, then we are waking up and falling asleep about the same time everyday.  This sets up our circadian rhythm to sleep deeply and through the night.  When we as adults have sleep problems, the best thing to do to fix it is set a time to wake up in the morning, and wake up that exact time, everyday, no matter how badly we slept the night before.  By doing so, our body adjusts and we are more able to know when to naturally fall asleep and stay asleep.  Babies are the same.  When their bodies begin waking up at the same time every morning, their day is able to adjust from that time forward, being consistent day to day, through the day and night.  Their bodies begin knowing when bed time is, and when it is day time.  Set that wake time in the morning!  As. hard. as. it. may. be!

Bedtime vs. Naptime: our bed time routine looks the same as a nap time routine, except that when the babies are young (until about 5-6 months) we usually bath them most nights.  This helps them establish, "it's bed time" in their mind.  You can't tell a baby it is bed time like a child, but you can train their bodies by doing the same thing every night: around same time nightly, bath, dark room, white noise, diaper/pj's, swaddle, feed, binky, cuddle, bed.  Or whatever your routine is.  

Define last feed of night so middle of night feeds can naturally drop off  (Dream feed):
When my second was younger we would put him to bed and then “dream feed” him at 10pm (or when we were going to bed).  He might technically be hungry at 11pm or 12am, if we naturally let him wake when he was hungry, but really that doesn’t matter and we would like to feed him when convenient for us.  By feeding him at 10pm, we would then let him wake up naturally at night.  He woke up 2am and 5am.  Eventually those combined to one night feed at 3am.  Then the 3am moved to 4am, 5am, and eventually he would sleep until the morning.  Once he was sleeping from 10pm to 8am we then started pushing back the 10pm feed to 9:45pm, 9:30pm, 9pm, until it met the time he went to bed for the night (12 hours before his morning wake up time).

So with all those things combined, I don’t need to do “cry it out” sessions or anything.  I listen to my baby’s cues and know where to step in and how to help him develop skills.  By following these steps, naturally the night time feeds drop off  and they create habits of taking solid naps. 

Here are some samples of schedules for different ages.  Of course, follow roughly- look for wake time lengths, amount of feeds, naps, ect.  

2-3 month old

8am: wakes up: feeds 5-6 oz
9:30am Nap
11am: feed 5 oz
12:30 Nap
2pm: feed 5 oz
3:30pm Nap
5pm: feed 5 oz
6:15pm Nap (no longer than an hour)
7:45: 3 oz bottle, bath, dressed in dark room and lotioned, swaddled, 3-4oz of more bottle, gas drops

Almost 3 month old:

7:30 am - eat
8:30 am - nap
10:30 am - eat
11:30 am - nap
1:30 pm - eat
2:30 pm - nap
4:30 pm - eat
5:30 pm - will take a catnap usually wakes up a little fussy - will usually have to hold - may feed early
6:45 to 7:30 pm - eat 
Bed by 8 (if eats at 7:30pm)
10pm - Dreamfeed
wakes at 5am for "night" feed - start day at 7:30

2-3 Months

7:30 Wake, Nurse
8:20 Nap
10:30 Wake, Nurse
11:25 Nap
1:30 Wake, Nurse
2:25-30 Nap
4:30 Wake, Nurse
5:30 Cat nap
6:30 Bath, bedtime routine
7:00 Nurse (Sometimes earlier if really tired)
7:30 Bed
10:30/11 Dreamfeed

 4 Months girl 

7:20 – wake up/eat (55 minute wake time)
8:15 – nap (2 hour nap)
10:15 – eat (60 minute wake time)
11:15 – nap (2 hour nap with help of swing ½ way through)
1:15 – eat (65 minute wake time)
2:20 – nap (2 hour nap with help of swing ½ way through)
4:20 – eat (65 minute wake time)
5:25 – nap (65 minute nap)
6:30 – wake (1 hour, 30 minute wake time before bed)
7:00 – eat8:00 – bed
10:00 – dream feed/10:30 bed
·                 
4-8 Months: 

8:00 wake, nurse
9:30 nap
11:30 wake, nurse
12:00 independent play time
1:30 nap
3:30 wake, nurse
5:30 nap
6:30 wake, nurse
8:00 nurse, bed

4-6 months: 

6:45 wake, eat (6 oz. breastmilk)
7:30 long nap every day
10:30 eat (6 oz. breastmilk)
11:45 nap some days
2:15 eat (6 oz. breastmilk)
3:45 nap some days
6:00 eat (nurse)
7:00 nap most days
8:30 bath and bedtime routine
9:00 eat (6 oz. breastmilk)
9:15 bed, sleeps through the night

5 Months girl 

7:00 – wake up/eat
8:00 – nap
10:30 – eat
11:30 – nap
1:30 – eat
2:30 – nap
4:30 – eat
5:30 – nap
6:30 – wake
7:00 – eat
8:00 – bed
10:00 dream feed/10:30 bed

6-7 Months

7:30 am wake/nurse
7:50 IP (Independant Play) in crib
8:15 mommy and baby time
8:30 breakfast
9:00 free time
9:15 - 9:20 nap
11:30 wake/nurse
11:50 blanket time
12:30 lunch
1:00 bath
1:30 nap
3:30 wake/nurse
3:50 activity center/play mat/read book
4:15 playtime with mommy
4:45 blanket time
5:15 catnap
6:00 wake + dinner
7:00 nurse
7:20 bedtime

Watching for Cue Signs:

It is best to read the baby’s signs and not allowing crying to be your cue to do something else.  It is best to allow babies to communicate with their cues and for the adult to “pick up” on these signs and follow through on them. 
Such as, reading a baby’s tired signs.  Babies sleep best when they are put down at the “perfect” time.  As the parent you should know about how long your baby’s wake time is during each time of the day and then you can read their cue signs of when they start communicating to you when they want to be put down. Cues changes with the babies age. These are some of the common signs, although there are many:

Tiredness:
Slight quieting, a lull in being busy, rooting to the side, pacifier or lovey, a slight staring off, decreased activity, slower motion, less vocal, sucking is weaker or slower, quieter, calmer, disinterested in surroundings, eyes less focused, eyelids dropping, yawning, less movement of arms and legs, eyes that are not as sparkling or eyes that look "glazed over", eyelids that droops a little, less intense staring, less socially responsive smiling, less engaging, rubbing eyes, irritability, pulling hair, thumb sucking, bating at ears and crankiness, rub eyes, rub face into blanket or shoulder, fidgety

Over stimulation (not enough sleep; too much lights/noise; kept up past being tired) :
-          Doesn’t want to make eye contact
-          Cranky
-          Not sleeping well
-          Fidgety

Bored:
-          Fidgety
-          Crying
-          Easily entertained by something else

Hunger:
-          “Na-Na” cry
-          Won’t fall back to sleep
-          Smacking lips
-          rooting

Gas:
-          Wiggly
-          Scretchy cry
Still tired (if woken up from a nap, but still wants to sleep)
-          Cry is specific to a “still tired” cry.  Whinnier, more drawn out, “mantra cry”
-          If given a binky or patted their eyes roll back

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