Ask the Pediatrician: How do I get my baby to sleep?

Virtually every day, pediatricians hear questions from parents worried their children aren't sleeping well. Concerns vary, since the sleep issues a toddler presents are very different from what we see in a busy high schooler. But by far, the parents who seem the most distraught are caring for babies under 1 year old.

After asking a few questions, pediatricians are almost always able to reassure these sleep-deprived folks that they're doing a great job. Hearing more about the developmental reasons for their baby's wakefulness, along with some new approaches to try, can be very validating.

In working with parents over the years, I've often shared stories of other families who found themselves in the same boat. This helps to remind parents that almost all loving adults have trouble getting little babies to sleep, at least some of the time (and possibly even every night).

One parent came to me with concerns about her 17-week-old baby, who had been born prematurely. This little guy was only sleeping through the night now and then, and his daytime sleep patterns were erratic at best.

As we talked things over, his worn-out mom was relieved to hear that her baby was behaving exactly as most preterm infants do. These tiny humans tend to wake more often at night than full-term babies, at least for the first several months.

With babies born preterm, night waking and lighter sleep reflect the fact that their breathing and circulation systems are still maturing. Preemies have to feed more often, which means they have to wake more often. This can be hard on parents, of course, but a healthy appetite (and steady weight gain) are a sign of good health for any preemie.

I reassured this parent that their child would settle in time, but they should be ready for some disrupted nights those first few months. Getting overnight help from her partner, family and friends might enable her to catch a full night's rest. This can help new parents stay healthy, balanced and more present to their children.

Another common question is if breastfeeding versus bottle makes a difference.

"My sister's baby started sleeping through the night when he was barely 3 months old," one very concerned parent shared with me. "My baby is 2 months older, but she wakes up two or three times every night! Can you explain what's going on?"

It didn't take long to get to the bottom of this one. The sister was feeding her child only formula, while this mom was breastfeeding. In the first few months, breastfed babies wake more often at night to feed (and also feed more often during the day). The good news is that, as they grow, their sleep patterns stabilize; they fall asleep and stay asleep more readily, achieving a healthy total sleep time.

Why does breastfeeding change a baby's sleep patterns? It turns out that human milk is a lot easier for babies to digest than formula. As a result, breastfed babies usually wake up hungry every two to three hours, relatively more frequently than their bottle-fed cousins.

By about six months, breastfed babies start sleeping longer. In the meantime, parents and caregivers can encourage healthy sleep by following these two tips:

Don't rush in at the first whimper. Wait a few minutes to see if your baby will fall back asleep on their own, which they often will.

Keep your baby awake while feeding. This gives babies practice falling asleep on their own, helping establish good sleep habits. You can keep a sleepy baby awake by gently stroking their cheek, giving them a little nudge, or talking and singing to them while feeding. Then return them to their crib while they're still drowsy and ready to drop off again.

In our sleep clinic, my colleagues met with a parent who said she felt like a total failure. "My 9-month-old used to sleep all night, but suddenly, for NO reason, he's waking up at least once," the parent said. "His teeth don't seem to bother him and he's not sick. Help!"

The sleep clinic team explained that night waking phases come and go in the first few years of life, often without any explanation.

When babies are healthy, well-fed, and comfortable—bedroom not too warm or cold, diaper not soaked and clammy—their crying may reflect that they're experiencing minor struggles with normal development. Even though they're causing others in the household to lose sleep, there may not be anything the parent needs to do.

The advice: When your baby wakes, try waiting to see if they will drift back off, which often happens if you don't get too anxious or intervene right away.

Babies may also begin to feel separation anxiety around this age, which is perfectly normal and temporary. At this stage, they may fear the loss of a primary caregiver or cry when strangers look at them or ask to hold them. Infants and toddlers experiencing this kind of fear might wake in the night, possibly crying out for one parent or caregiver in preference to others.

Try not to take it personally if you're not the one they want at this moment. If you're the "first responder," give your child a few minutes to settle back down on their own. If the crying continues, keep the lights dim as you check to make sure everything's all right. Pat your child and reassure them but avoid picking them up.

Leave the room as soon as they're calm but still awake so they can practice soothing themselves back to sleep. (It's also great to play peek-a-boo with your little one during the daytime so they get used to the idea that when you disappear, you'll always come back again!)

Infant sleep patterns change frequently, so don't feel bad if you're totally stumped when this happens with your baby. And don't forget: Your pediatrician is there to help you figure things out. It might be just part of healthy development, or perhaps your child should be screened for other issues that can affect sleep. Whatever the case, your baby's doctor can be a real source of comfort, wisdom and reassurance.

For more information, go to HealthyChildren.org

Rachel Y. Moon, MD, FAAP is a pediatrician and researcher at the University of Virginia. who also teaches pediatrics at UVA's School of Medicine. Her research centers on sudden and unexpected infant death, a serious health concern that claims the lives of nearly 3,400 infants in the U.S. each year. Dr. Moon is chair of the AAP's Task Force on SIDS and the editor of "Sleep: What Every Parent Needs to Know."

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