Your baby’s 4 month sleep regression: Why it happens and how to survive it

Just as you were starting to feel like you were getting a handle on this sleeping baby situation, your sweet newborn decides to change thing up on you right as you approach the 4 month mark. This is fondly (or dreadfully) referred to as the 4 month sleep regression. While some have heard of it before it afflicts their family, others are in denial that it will happen to their already sleeping champ of a baby, and other families are caught completely off guard and can’t figure out what they have done wrong. Regardless of the many emotions that surface when your baby enters this phase, it is normal and survivable although undeniably painful at the time.

What is the 4 month sleep regression?

This time period is often a rocky one due to a variety of events that seem to happen simultaneously. Most importantly, this is the moment of time when your baby has a significant “burst” of developmental awareness. This means that some babies (although not very alert babies) for the first several months of life are not very interested in things that are going on around them other then probably the sound of their mother’s voice and whether they are being fed. Their world is rather limited to the immediate vicinity. As they move into this 4 month period, they suddenly become aware that there is an entire exciting world all around that they want to engage with and investigate. When everything around you is so stimulating, it can certainly make it hard to sleep. This means that your baby is likely to become very distractible at this point in time. Remember the days of endless cluster feeding when you could catch up on all of your Netflix marathons and your baby was none the wiser? Now, you turn on the TV as you sit down for a feeding and suddenly your baby cranes his neck to see the screen too, to the detriment of the feeding. Or you try to feed your baby in a public place or where your other children or even the dog are running around and forget it, not going to happen. Everything else is way to interesting to spend precious moments eating.

For many babies, there is also a growth spurt at this time. While growth spurts are hard to predict and there are several of them, especially in the first 6 months of life, many babies will begin eating more around this 4 month mark. This can certainly account for increased night wakings and the reluctance on your child’s part to go back to sleep without a feeding.

As your baby moves out of their 4th trimester (that initial 3 months after birth when he is adjusting to the world out of utero and you may be still helping him simulate that in utero experience with your 5 Ss –sucking, swaddling, shushing, side lying and swinging), many of the tricks you might have used in those early months may stop working. While this can be frustrating because it means that you have less ability to soothe your baby to sleep, it is a sign that your child is growing and developing and needs less intervention from you in order to soothe. This is not to say that all babies are ready to soothe independently at this stage but that this skill is starting to become more developed.

Lastly, some babies like to learn new tricks at this time such as rolling from their backs to their bellies. It is likely that if your child is doing this when they are not in their sleeping space, you will have some advance warning that they are capable of rolling back to belly and are no longer swaddling, as this can be dangerous. If your previously sleeping baby suddenly wakes up in the middle of the night and finds himself on his belly, he is likely to wake up mad and need some help getting comfortable again in order to back to sleep.

When does this regression typically happen and how long does it last?

On average, I find most parents report that they begin noticing changes in their babies around 15 weeks (for babies born prematurely, this would be 15 weeks adjusted). Not all regressions happen to all babies so it is possible to get through this period of time and not notice a significant difference in your child’s sleep. On average, I find that the regression lasts anywhere from 2-4 weeks. If it is not resolving by 4 weeks and especially if your baby is beyond 18 weeks, it may make sense to start making some changes because this is an indication that your child might be ready to be more independent with their sleeping.

How do we survive the 4 month sleep regression?

Your baby is in the midst of big changes! This is a good thing because it means that your baby is growing and developing. At this time, your baby’s brain is starting to cycle in and out of stages of sleep just like the adult brain which means that your baby is starting to notice that there may be a difference between what happens when he is falling asleep at bedtime (for example: he is held to sleep, nursed/bottle fed, rocked or bounced to sleep) and what happens when he now goes through those newly developed sleep cycles. If he went into his sleeping space asleep, he is going to be more likely to wake at when the next sleep cycle occurs.

During this time, there is going to be a fair amount of survival that needs to happen. This is a tough time for your baby too as his brain is growing rapidly and the world around him is quickly expanding. It is fine to do whatever you need to do to meet his needs. Many times a day, I tell parents that there is nothing that they are going to do regarding their baby’s sleep in the first 6 months that is going to cause a long term problem (and even then, it can all be changed, there are just varying degrees of how hard that process can be). Please keep in mind that he may be in a growth spurt so he is likely to have an increased need for nutrition so feedings may be more necessary then they might have been a few weeks ago. You may need to be a bit creative about how your are helping your baby go to sleep during this time as things that worked in the past may not work as well at this point (sadly, this is often the point when those 5 Ss stop working so well). Ensuring that your baby is not overtired will help him sleep more easily so watch for sleepy cues and try to get him down before he is overtired.   This may also be the time when you have a harder time convincing your baby to sleep when you are out and about because of all the stimulation that the outside world is now bringing in. If your baby will still sleep while you are out, it may be helpful to cover the carseat or carrier to reduce some of this stimulation.

How to we get out of this regression?

Babies are not born with the ability to soothe themselves to sleep. Some are better at this then others from younger ages, but when this happens is often based on your child’s temperament. Babies with easier temperaments can often start to soothe themselves and fall asleep independently starting at 8 weeks of age. Please note, this is not through sleep training. This refers to babies who can be put down awake in a sleeping space and, after a brief period of rocking themselves side to side, lifting their legs up and dropping them down—soothing behaviors—fall asleep on their own without needing a sleep crutch. If this is happening prior to the 4 month regression, when you get to the other side, sleep can often fall back into place as your child has the skills he needs to be a great sleeper from here on out.

If your baby goes into his sleeping space asleep at bedtime, the 4 month regression can often bring about wakings every 2 hours (or more!) throughout the night and he may be very hard to soothe at some points. I typically tell parents that if you have come through what is a usual point in time when the regression should be over (about 18 weeks) and your baby’s sleep is still very challenging, this can be the point in time when it may make sense to start to work on developing some improved sleep skills. This will likely involve some sleep training. Sleep training is not something you ever have to do if it is not in keeping with your parenting comfort zone or it may be something you feel would be better for your child if you held off until 6 months. I often find, however, that when parents are going through a circus act of tricks to convince their baby to go to sleep and none of them are really working, it can be because your child is telling you that he is ready to do some of the work himself.

Not sure if your baby is in the midst of their 4 month sleep regression, feel free to contact me for your free 15 minute phone consultation.

Building your bedtime routine

A question I hear all the time from new parents revolves around bedtime routines. How do we create one? What goes into a bedtime routine? Why should we do a bedtime routine? When do you do the bedtime routine? Here are some answers to all of these very important questions.

Even as adults we have a bedtime routine. For adults, this may mean that we brush our teeth, we wash our face, we change into pajamas or something different then we were wearing during the day, maybe we read a book or some adults watch TV (which is the number one sleep crutch among adults in the US but that is a topic for another article). This process is important because it helps our brains prepare for the process of falling asleep and also helps it begin to produce melatonin, the hormone that helps us to fall asleep and stay asleep for long stretches at a time. The bedtime routine for a baby or child serves the same purpose.

Babies as young as about 8 weeks old can begin to appreciate a bedtime routine. Sometimes the question of what point in the night to start this becomes a challenge to figure out because bedtime may not yet be a fixed time. In fact, newborns typically have very late bedtimes (starting as late as 11 or 12 at night and gradually creeping earlier) until about 3-4 months old when it usually shifts to some time between 6 and 8pm. Yes, I realize that for newborns, bedtime really may just be when you finally turn out the lights and change into a different pair of sweats and try to catch a couple of hours of sleep before the next waking and feeding. As your baby approaches 8 weeks, it is a good idea to begin to incorporate a bedtime routine prior to whatever seems like it will be bedtime.   Don’t worry if your child doesn’t actually fall asleep soon after the bedtime routine. That is okay. Eventually it will become easier to determine when that day’s bedtime really is (I say “that day’s bedtime” because until nap schedules start to evolve, which may not be until close to 6 months or sometimes a few months later, the actual bedtime may move around a bit based on when your child woke from their last nap).

Bedtime routines for babies

I will typically encourage parents of babies to keep bedtime routines pretty short and concise. It doesn’t need to be longer then about 20 mins and this is often including a feeding. This is partly because babies are sometimes very tired by the time the day comes to an end so a long drawn out bedtime can lead to them becoming more overtired and exhausted. The other reason to keep it short is because as your child grows and you move into the toddler and preschool years, your child will likely want to add on to their bedtime routine with an amazingly creative variety of stall tactics. If your routine was pretty short to begin with, it has some room to grow before it is taking 45 minutes to an hour to get through your bedtime routine. For babies, bedtime often entails a short bath or maybe just a brief washcloth wipe down. When you come into the room where your baby will be sleeping, it is a good idea to turn down the lights and turn on a white noise machine if you are going to use one. You are then light and sound changes to create associations between the things that are changing in your child’s environment and what is about to be happening (going to sleep for the night). Many families like to do a short infant massage as they are putting on lotion, a diaper and pjs. You can certainly attempt to read a short book if your child isn’t too tired, but for many infants, they don’t have the attention span to read a book or they are so tired that they are trying to eat the book or hit it away. If this is the case, don’t stress, there are plenty of other great opportunities in the day to read to your child. For babies there is often a feeding as part of the bedtime routine. Where to put this feeding in the process is often related to how old your child is and if you need to use the feeding to help your child fall asleep at bedtime. I speak with moms all the time who will say “I nurse my baby to sleep…I know this is bad” or “my baby falls asleep drinking his bottle…I know this is bad.” Neither of these things is bad. It is only something to change when it is no longer working well for your family and also when your child is at an age when he is more capable of putting himself to sleep without needing the help of a sleep crutch to fall asleep. When you are no longer nursing to sleep or feeding with a bottle to sleep, I have parents move the feeding to before the bath or before the pjs go on. I will also often suggest to families that they just walk around the room, saying good night to three things in their child’s room and sing a song before putting their child in the crib for sleep. These are further associations that your child will make between what happens prior to going to sleep and then what is coming next.

Bedtime routines for toddlers and preschoolers

For older children, more often they may have a bath regularly at bedtime, especially in the warmer months when they are outside, playing hard and getting dirty, or after a particularly messy dinner. Following last trips to the potty and teeth brushing, return to your child’s room for pjs and stories. As children reach the toddler years, the more parts of your bedtime routine that you child can make choices about, the better as going to bed is not a choice. For instance, your child can choose which toothbrush from 2 or 3 he wants to use, he can pick out his pjs, he can choose a few books to read (be sure to set consistent limits with books otherwise you will end up reading until you fall asleep yourself!). Some families prefer to play a quiet game or do a puzzle before bed. These are also great ideas. Then come kisses, maybe a song and the final tuck in. I always found it helpful to also ask my kids of there was anything else they wanted to ask me before I say good night. They often asked some silly, nonsensical question, but this seemed to head off a call back as it gave them a chance to get the last of their words out for the day. While bedtime for toddlers and preschoolers may sometimes feel like the home stretch after a long day, keeping that routine consistent and predictable is essential and will set you up for a smooth transition to sleep.

Sweet dreams!

Taming toddler sleep shenanigans

Ahh toddlerhood…What a wonderful time! Wait, who am I kidding? Any parent of a toddler will tell you that this can be a very challenging time for both children and parents alike. It is an incredible combination of your child learning that he is a unique and individual being with his own set of likes and dislikes and also the knowledge that he can start to be in control of various parts of his life like dressing and undressing himself, going to the potty and making demands such as “I do it myself!” even if it is not something that he is fully capable of. Don’t get me wrong, there are a lot of great parts of toddlerhood like the lightening speed at which he is learning new words or his ability to recall events or obscure details that you long forgot (an inconvenient combination of this is the way he recalls the exact words you used when you discovered a parking ticket on your car 3 weeks ago!). It is an understatement to say that this can be a very challenging time for parents. Despite our brain’s convenient ability to forget the challenging parts of parenting as they fade into the past, I still vividly recall my daughter’s toddler years (she is now 10!) and how every night of toddlerhood, I would fall, with exhaustion, into bed and think to myself “that is one less day of toddlerhood that I have to survive.”

toddler sleep troublesSo of course, when it comes to sleep, toddlers can present new and unique challenges that may differ from what you experienced when your child was a baby. Here is just a smattering of what I refer to under the general heading of “toddler sleep shenanigans” as well as some tips to survive them.   Some of them are endearing while others may make you swear (either under your breath or more audibly) and wonder “why oh why does the hardest part of the day have to be at the end of the day???!!!!”

Your basic stall tactic

You’re in the home stretch. You’ve brushed teeth, put on the PJs (which may or may not have felt like a wrestling match worthy of WWF), read the books and you’re ready for that final tuck in (you’re so close!) when your child innocently requests a last sip of water. So here you go, back into the bathroom to fill up the cup and while you are in there, he suddenly has the urge to poop which rivals the time your husband spends in the bathroom as soon as he walks in the door after work. Now you have made it back into the bedroom but you must say good night and kiss each and every one of his stuffed animals and tuck them in as well. Before you know it, bedtime is now 45 minutes later then you intended it to be.

What to do: toddlers love their routines and predictability. They also respond well to having the expectations and limits laid out ahead of time. But like anything else with children, when you set a limit but don’t stick to it (inconsistency), your child will push you harder and escalate more quickly to a tantrum. Be sure that your limits are things that you are prepared to follow through on. To handle the last ditch attempt stall tactics, try to preempt as much as you can as telling your child while you are in the bathroom brushing teeth “this is your last chance for sips of water,” “this is your last opportunity to go potty before morning, do you want to try to go now?” And even presenting your toddler with the opportunity to make a last request of you before you walk out like “do you have a last question for me?” This helps them feel like they have the chance to make choices during a process that ends with something that they don’t have a choice about: going to bed. When your toddler protests, be very clear that he has gone to the potty or had his last sips, you will do those things again in the morning. And stick to it!

The call back

You have successfully escaped the room but are now being recalled for one of many “very important” requests. This can be anything from “my finger hurts” to “I’m hungry” to an immediate need to discuss something he learned at school that morning.

What to do: keep interactions brief and try not to troubleshoot and problem solve too much. It is likely that the more you try to come up with solutions to whatever the issue is, the more your child will find other things to request

ticket1For older toddlers (3 and up), some children are capable of understanding a “ticket system” which involves giving your toddler 2 or 3 tickets at bedtime and explaining that every time there is a call back, he pays a ticket. If he has tickets remaining in the morning, he can earn a small prize. The prize doesn’t have to be anything grand, depending on your child, a sticker might even suffice.

The early morning wake up call

Just as you were trying to get in your last hour or two of sleep before the alarm goes off, in walks your human alarm (aka: the toddler), ready to start the day. You glance at the clock in disbelief because it can’t possibly say 4am.

Okay to wake clockWhat to do: Early rising (as waking between 4 and 6am is know) is one of the most painful and stubborn sleep behaviors to resolve in children. There are some very specific factors that contribute to early rising that you should certainly read up on. Beyond those factors, I highly recommend behavior modification clocks for toddlers, such as the Okay to Wake clock. This clock looks one way when it is time for sleeping (in this case, a soft yellow color) and different (green) when it is time for your child to wake up. You can set the wake up time on the clock (I recommend starting at 6am and then as your child becomes successful at sleeping until 6, you can inch the time later) and teach your child that when it is yellow, it is bedtime/sleeping time and when it turns green, it is okay to get up. If he wakes before the clock is green, he has to go back to sleep. Unfortunately, these clocks don’t work their magic on their own. As a parent, you will need to reinforce it. So, if your child wakes before his clock turns green, you will need to tell him that it isn’t morning, the clock doesn’t say it is and he needs to go back to sleep. It’s okay to blame it on the clock. If, however, you allow your child to get up before the clock changes, the clock becomes meaningless.

There you have it, just a few ways to troubleshoot some of the more challenging toddler sleep behaviors, for more answers to your toddler questions, visit Sleep Tight Consultants on Facebook or contact me to schedule a free 15 minute phone consultation.


Keeping sleep on track with grandparent visitors

Sleeping baby in grand mothers arms

Just when you thought you had all of your child’s sleep challenges worked out, here come the grandparents for a visit. While grandparents mean well and are absolutely fulfilling their grandparently duty by spoiling their grandchildren, I believe it was Dr. Marc Weissbluth who called grandparents the “enemy of sleep.” Make no mistake, they, of course, do the things they do out of love, but they often don’t adhere to the same limits that we work so hard to establish for our children. Here are some tips to help everyone get through these visits with minimal disruption.  Although we will mostly be talking about grandparents here, these tips and guidelines can apply to any visitor who disrupts your children’s daily routines.

For the sake of clarity, we will discuss the challenges that grandparents present as two separate categories: those related to grandparents who come in town to visit for brief periods of time and those who live locally and may take on more ongoing caregiving responsibilities. Visiting relatives tend to cause short term (although still stressful) disruptions where as if you have a relative caring for your child on a regular basis, this can have many more long-term consequences for your child’s sleep.

So why do we run into trouble with our children’s sleep when grandparents visit? There are a variety of reasons and ways that they may present challenges. Most commonly, I hear from parents that their children becoming more overtired when grandparents are around. Remember, your parents haven’t had a small child to care for in probably 30 years (give or take a few years). It is highly unlikely that they remember what the actual, day to day, experience of having a small child is really like. We repress those early memories very quickly so that we might someday decide to have another child and therefore the human race can continue. If parents forget the experience of having a small child after just a few months, imagine what 30 years must be like? Just try asking a friend of an 8 year old if they remember what it was like to get their child to sleep when he was a baby, and it is likely that she already doesn’t really remember how that actual experience felt. Although grandparents love their grandchildren, if they visit sporadically, they don’t know how to read your child’s tired signs like you do. While you may read your child’s glassy eyes and louder then usual vocalizations as signs that your baby is ready for a nap, grandparents often read that as boredom and a call for increased activity/stimulation (which you know is exactly the opposite of what your baby needs). You probably have heard a grandparent or two utter the words, “he doesn’t look tired to me.”

Another challenge is that children often become over-stimulated or excited when a new person shows up. Whether this causes a problem for your child is largely based on his or her temperament. Some children adjust fine to having new faces around whereas others have a harder time winding down when there are visitors in the house. For children who are very sensitive to disruptions in their routines, new and unusual family outings related to the visitors may also contribute to some sleep setbacks.

Lastly, it is unlikely that your visiting relatives have had as much recent practice at skills like “door closing, ninja-style,” “silent dishwasher emptying,” and generally not clomping around. They also don’t think about when the optimal time (meaning NOT naptime) might be to do a noisy activity such as taking out the garbage or calling the airlines on speaker phone.

Here are some tips for handling stressful grandparent visits:

  • Communicate, communicate, communicate. Ideally before the visitors come to town so you aren’t discussing these issues in an already escalated circumstance. If there are things that have frustrated you on previous visits, make a point to discuss it prior to the upcoming visit so you don’t have a repeat problem.
  • Point out things that you do that are important. Most often, I hear from families that I have worked with that things were going great with their child’s sleep and then grandma came to visit. Because grandma loves to hold her grandson, she rocked him to sleep for all naps and bedtime. Now, a baby who was going down for all sleeps awake will be again used to rocking and when you go back to your routines, expect protest. Let’s give grandma the benefit of the doubt. Maybe she didn’t know how hard you worked to help your child learn independent sleep skills. Talking about how you have helped your child to fall asleep without rocking can, not only help to clear the air, but also prevent future regressions after visits in the years to come. If your relatives are watching your child and will be putting him/her to bed, have them watch you do it (if possible) before they are responsible.  Tell them what you do if your child protests going down. Help them have the tools to respond to they don’t feel like they have to resort to using a sleep crutch, which will be a quick fix but could cause more long-term troubles.
  • If your baby or toddler becomes over-stimulated before bedtime due to visitors, spend some extra time before bedtime winding down (without the visitors). You can do all your good night kisses with your visitors before going into your routine but then give your child some extra quite time in their less stimulating room. Maybe you read an extra book that night, do a quick puzzle or sing a few songs.

What if the grandparents live locally and either care for your child while you work or you make frequent trips to their home where sleep may be required? This may necessitate a firmer set of limits.

  • As with grandparent visitors, communication is key. Regardless of who cares for your child when you are away, there is always a degree of control that we have to give up when someone else is caring for our children. No one is going to do things exactly the same way you do. If your parents or in laws are responsible for caring for your child, try to prioritize what is important about how they care for your child and handle sleep. This may mean that you have to pick your battles. Maybe it is most important to you that they adhere to your rules about your baby going down awake but getting them to wind down early for bedtime may be asking too much. If your parents watch your child frequently, they may learn the hard way what happens when your baby becomes overtired and then have more incentive to adhere to your limits.
  • If they can stick to your same routines, more or less, this can be helpful with creating consistency. Try to create as much of the same environment for sleep as possible. This is true if you spend every weekend in the suburbs or if your child goes to grandma’s house every day while you are at work. Here is where having a bedtime/naptime routine and a security object can be particularly helpful. If your child understands the association between the routine, having his blankie and going to sleep, it can make that experience much easier, no matter where he is.
  • If you want your baby to be able to sleep at grandma’s house on the weekends (especially without you), practice. The more you are able to make the experience of sleeping someplace different, a familiar experience, the easier it will be.

In our world where families often live far apart, grandparent visits are a reality for many families.  When they relationships are good and the communication is open, growing up knowing and having a relationship with one’s grandparents is a gift to your child.  Working together with your family to help your child sleep will lead to a much more relaxed visit and enjoyable time for everyone!


Toddler transitions: 12 to 24 month sleep

12 to 24 month toddler sleepToddlerhood often presents a whole new set of sleep challenges for children and their parents.  I often tell parents that up until about 1, parenting is largely about management.  Gaining some semblance of control over the peeing, pooping, spit up, sleep, etc.   Once your child turns one and begins toddling as well as really taking in all the information you are relaying to him and also responding back, this is where parenting really begins.  Your child is now becoming a truly interactive human being.  This may mean that your toddler is starting to express some strong opinions about when and how he wants to sleep.  What follows is an outline of what to expect between 12 and 24 months.


Many children are starting to figure out walking around 12 months.  This can often throw sleep for a loop.  Like all developmental milestones, this new skill has the potential to derail sleep and lead to a regression.  Practice, practice, practice!  The more your child is practicing his new skills in the waking hours, the less he will feel the necessity to practice when it is time for sleeping.  This regression can often lead parents to think that their child is ready to move from two naps to one.  Ideally, your child will hold onto his two nap schedule until at least 15 months.  I would also not recommend moving to one nap until your child is sleeping through the night.  It is very hard to make it to one nap without a good, solid 11-12 hours of night sleep.  Certainly some will be able to transition to one nap sooner then 15 months, but if you can make it to 15 months, you will be in a better spot for less night sleep disruptions, potential night terrors and early rising.  This article has a lot of important information to keep in mind when moving from two naps to one.

There can also be another regression at 18 months and 24 months.  These often have much to do with increases in separation anxiety and sky-rocketing verbal skills.  Along with all the other things you are attempting to do as a parent, 20 minutes of concentrated, eye to eye contact at the ground level with your toddler can significantly help with separation anxiety.  When children feel close connections with their parents, it strengths the feelings of attachment and ultimately make separations (of which night time is the biggest separation they experience all day) easier in the long run.

Two naps to one

By 18 months, most children have moved to one nap.  The nap typically starts at noon, at the earliest, (and is proceeded by lunch so that your toddler can begin to understand the new order to the day—wake, breakfast, play, snack, play, lunch, nap, snack, play, dinner, bed) and ideally lasts at least 2 hours.  Many parents are worried about the large window of time that now exists between morning wake up and nap.  Your child will adjust to this window.  Usually there is a tough patch between about 10 and 11am where your child will look super sleepy.  This is a good time to offer a snack and get outside for some fresh air to help rejuvenate.  The window of time that is now much more significant is the time period between waking from the nap and bedtime.  This is the one that we don’t want to be too long.  At 18 months, you want to aim for this window to be not much more then 4 hours if it can be avoided.  When children move to one nap, bedtime often moves earlier to minimize that gap between waking from the nap and going to bed.  As your toddler approaches 24 months, some children are fine with a 5 hour window between nap and bedtime.  If your child looks very sleepy around dinner time and then gets a burst of energy before bed (this is that rush of cortisol from being overtired), it can be a good indication that you need to move bedtime earlier.  A typical schedule for a child over 18 months is:

Wake:  6-7am

Nap starting 12-1pm, lasting approximately 2 hours, may be longer

Bedtime:  7 (may need to be even closer to 6 or 6:30 for some children right after transitioning to one nap) and sometimes moving again closer to 8 as your child gets older.

Bedtime routine

I would not advise moving a child to a toddler bed/or non-crib bed before 2½ years old and holding out until closer to 3 years old has many benefits as well.   Stall tactics also begin to emerge in toddlerhood.  In theory, as parents, we should be flattered by this.  Toddlers stall at bedtime because they want to spend more time with their favorite people:  You (their parents)!  Bedtime is also that moment in the day when we are most worn thin (either by being at our outside-the-home jobs or our extra strenuous job for caring for a toddler all day long) and are in the biggest hurry to shuffle our toddler off to bed for some much needed grown up time (which often involves clean up and collapsing into our own beds).  Toddlers are very smart, they know this.  Taking your time to go through a consistent and predictable bedtime routine will help your toddler settle into bedtime with less struggle.  Routines should be generally the same each night to give your toddler some sense of control and also offering as many choices as possible.  Here are some things your toddler can choose:  their toothbrush (offer a two choices), their pjs (select from two pair), the book(s) to be read (careful not to fall in the “just one more story” trap, offer 3 or 4 and let your toddler pick 2).  With regard to stories, give your toddler warning when it is the last book or the last pages.  Then stick with it.  Inconsistency will lead to tearful and escalating begging for “just one more!!!!”

When my daughter (now 9) was a toddler, I went to bed each night telling myself that I now had one less day of toddlerhood that I had to survive.  I recently heard someone say “if toddlers were 6 feet tall, we would have a much higher murder rate in society.”  Toddler mood changes and demands can be fierce as they are rapidly figuring out the world around them with little self-control to guide them.  Offering consistent and predictable routines with as much patience and understanding as you can muster will help you through tough time.  Hang on, it can be a rocky climb, but your more rational little person will hopefully be meeting you on the other side of the toddler mountain.

Baby’s growing up: Transition from the swaddle

swaddled babyWhen babies are first born, they are a bundle of nerves. Every little thing can startle them. When it comes to sleep, there is nothing more frustrating then putting in all the work to get your newborn to sleep and then having them startle awake 20 minutes later. Since we now know that it is safest for babies to sleep on their backs, swaddling has become a more common place solution to helping babies sleep and not startle awake. It is likely that when you were a baby, you slept on your tummy whereby the mattress muffled the startle reflex. This is why many grandparents today don’t understand the need for swaddling.

Some babies hate being swaddled. They fight it, they struggle when swaddled and many a persistent parent has thrown in the towel and their baby has eventually adjusted to sleeping unswaddled. However, some babies LOVE it and their parents’ couldn’t imagine them ever sleeping without it.

Swaddling isn’t meant to be a long term situation though. At some point, your baby will outgrow their need to be swaddled or you may find it necessary to stop swaddling. This can be a scary prospect if you wondering how you are supposed to get your baby to sleep without the swaddle. On average, most babies are swaddled until somewhere between 3 and 4 months of age. Some outgrow it on their own and sometimes you need to put in more effort to wean it. There are some clear reasons to stop swaddling. Those are:

  • If your baby rolls over in the swaddle, you will need to stop swaddling. This becomes a safety issue because if your child rolls in the swaddle and is now on his tummy without access to his arms to push himself up, it can be dangerous. Please don’t misunderstand though, you do not need to stop swaddling if your baby has just rolled over for the first time in a non sleeping/non swaddled circumstance. It may still be quite some time or never when he attempts this trick swaddled.
  • If your baby is fighting the swaddle and seems happier and is sleeping better unswaddled, no matter the age, then it may be that he is ready to not be swaddled anymore
  • You notice that your baby isn’t really startling

If either you have had to stop swaddling for any of the reasons above or you feel like the time has arrived to stop swaddling, here are some tips for helping everyone make it through the process a little easier.

  • Know that there is likely to be some regression when your baby first starts going to sleep unswaddled. This is a big change for your little one and one that will take some adjustment. Be patient. Once babies can roll themselves from back to front and front to back, most pediatricians will agree that your child can sleep in whatever position he gets himself into. There are two reasons for this:  1) because your child is then strong enough to maneuver himself out of an uncomfortable position and 2) because there is little you can do (other then hover over your baby’s crib all night) to keep your baby on their back at that point. Please check with your pediatrician to find out their recommendations.
  • Parents often report to me that their baby has “crazy hands” when unswaddled. This most often resolves itself when your child is old enough to begin self regulating and putting himself to sleep. He will also figure out what to do with his hands. In the meantime, however, you can start by only unswaddling one arm initially. I typically suggest the nondominant arm which most often is the left arm. It tends to be less “flaily.” I will also often suggest continuing to swaddle a baby around their core area. This will continue to create the pressure that your baby is used to while still giving him access to his hands. This can be done with a swaddling blanket (assuming it can be done safely and stay tucked in) or if you are using a Halo sleep sack, rather then wrapping the arm flaps around the arms, you would just wrap them around your baby’s abdominal area.
  • You can also introduce a security object that your baby can hold onto while falling asleep. This can often give your baby something to do with his hands, and it is also extremely helpful when creating sleep a new sleep association as the swaddle doesn’t just muffle the startle reflex, but it is also a strong sleep association for your baby.
  • If your baby is younger then 3-4 months, on the bigger and of the growth chart, and is not able to be swaddled anymore, another option is to transition to the Baby Merlin’s Magic Sleepsuit. The Magic Sleepsuit was developed by a pediatric physical therapist. It is a padded suit that is designed to create pressure on your baby’s body that will prevent him from startling. The other purpose is if you have a baby who wants to roll himself from his back to his front but is then stuck on his belly and very unhappy there, the Sleepsuit will keep him on his back and prevent him from rolling. It comes in two sizes, 3-6 months and 6-9 months. I find that bigger babies do better in it because they “fill it up” more, creating more soothing pressure on the body.  ***if you purchase the Sleepsuit on their website, enter promo code sleeplady20 for a 20% discount.
  • There is no rule that says you have to unswaddle for naps as well as night sleep. Night sleep and day sleep are controlled by two different parts of your baby’s brain and at a young age, it is not typically confusing to unswaddle at night but not during the day. If you have stopped swaddling for both nights and days and find that your baby is now waking from naps much sooner then he did with the swaddle, it is okay to go back to swaddling for naps until your baby is a bit older and can handle not being swaddled for naps. Children sleep in a deeper stage at night then they do during the day and in the early months, this can make it much harder to stay asleep during the day without needing a little “help.” Day sleep does not come together for many babies until closer to 6 months.

Hope these tips are helpful! Have no fear, your child will not still need to be swaddled in kindergarten 🙂

Toddler transitions: 2 naps to 1

Yawning toddlerJust when you thought you had this whole child sleep thing figured out, your toddler goes and changes things on you. So frustrating! By about 9 months, most children are taking two naps but as they move closer to sometimes a year and most often 15-18 months, they will begin to only need one nap. Here are some helpful things to know about this transition from 2 naps to 1.

How to know its time for one nap:

  • Your child is between the ages of 15 and 18 months. Sure, some 12 month olds will try to go to one nap. This is often associated with new-found developmental skills like walking. Walking is a big new step in your toddler’s life that requires a lot of brain work. This, in turn, can often seem much more interesting then sleeping during the day. If your newly turned one year old is on the cusp of walking and is also fighting naps, I would give it some time before you give up on two naps entirely. Below are some tips for helping to hold onto two naps for a little longer. Yes, I have seen some children who are younger 15 months who are able to handle one nap. It’s not ideal, but some children are really not good nappers until they consolidate their day sleep into one time per day. However, if you are using sleep crutches to get your child to sleep (holding, rocking, feeding, bouncing, etc), it is likely that it will look like your child is ready to go to one nap long before they are really ready. This is because in order to successfully use crutches to get your child to sleep, they have to be very tired. As children get older, and especially in the afternoon, they are less tired. Therefore, it will take more work to “induce” your child to sleep using crutches. If this is the case, teaching your child how to put himself to sleep using sleep coaching can solve this problem. I have seen children who haven’t taken two naps in months go back to easily taking two naps a day once they are sleeping independently.
  • Your child spends their whole morning nap talking, playing, singing and never falls asleep.
  • Your child spends the whole morning nap talking, playing, singing and then falls asleep right as you are about to get him up at 11am.
  • If your child no longer seems tired for their morning nap for a period of about two weeks, rather consistently.
  • Your child decides he loves his morning nap, couldn’t imagine not taking it but then won’t fall asleep in the afternoon. This is more problematic and a less desirable way to drop a nap because when you move to one nap, it needs to happen in the afternoon and not the morning otherwise you will end up with a very long window between the morning nap and bedtime. This often leads to late afternoon meltdowns (by parent and child), bedtime struggles, and early rising.

How to make the move to one nap:

When children are showing the indications (see above) that they are ready for one nap, it is important that this nap happen after noon. On average, when children start taking one nap, it may be that you can hardly make it to twelve o’clock before your child looks like they will pass out. As his brain adjusts to being awake through the morning, this will get easier. There can often be a real rough patch between about 10 and 11am where your child is showing all the signs of being tired. You know that if you put him down for a nap, he will sleep but that will likely mean that is the only nap you get for the day. It’s too early. This is the time to work on rejuvenating your toddler with some fresh air, snacks and distraction. I typically suggest then giving your child an early lunch and then nap after lunch. This will help your child start to organize how they think about their new routine: “I eat lunch and now I take my nap.” Remember, you have a toddler now and they love routines and predictability. Some parents will start by moving the nap to 11am but be very careful that you don’t get stuck there. If your child naps from 11-1pm, you will end up with a long window to bedtime. As your child approaches two years old, the nap often moves closer to 1pm and sometimes even later as you move further into toddlerhood.

Things to keep in mind:

  • Your child may not be able to handle one nap every day quite yet.
  • It is okay to do a day or two of one nap and then a day or two of two naps to keep your child from getting too overtired.
  • When children go to one nap, it may be only the length of one of their naps from before. For example, if your child was taking two hour and a half naps, when he goes to one nap, he will probably initially take one hour and a half nap. It will take his brain some time to figure out that he is only going to get in one opportunity to sleep for the day, and he has to consolidate all his daytime sleep into that one nap.
  • If every day you are doing one nap still feels like a struggle, and it’s not getting better, its okay to go back to two naps until you just really cannot make it work anymore. Incidentally, I did this with both of my kids when they were transitioning to 1 nap.

What to do if you know your child still needs two naps but you can’t make it happen

This commonly happens somewhere between 12 and 15 months when your child will start fighting one of the naps (most often the PM nap) but you know that he’s not ready to make it through the whole day on one nap.

  • Make sure that your child’s naps are already no earlier then 9 (for the AM nap) and 2 (for the PM nap). If they aren’t there yet, move them so that they are happening at those times.
  • If your little one wants to take a nice long morning nap and then no nap at all in the afternoon, one option can be to shorten the morning nap. I have had families shorten it to even 30-45 minutes in order to create enough sleep pressure to be tired enough in the afternoon for the nap. This, of course, can backfire because if your child’s brain will only allow him to fall asleep one time during the day and you have shortened that one time, then it’s going to be a long, rough day.
  • You can lengthen the awake time between first and second nap. Start with 2:30 if you aren’t already there and then you can push that PM nap as late as 3 or 3:30. It may not be long but you just need to get it in. Incidentally, because of this late PM nap, I find that children in this age group have some of the latest bedtimes because they wake at 4 or even a bit later from their nap and can easily be awake 4 hours before bedtime. ****This bedtime will need to move earlier again when your child goes to one nap in order to shrink that window between nap and bedtime.
  • As a last ditch effort, in cases where a child just cannot make it to a nap at noon but trying to make two naps really happen is no longer working, I will have parents do a 15 minute car nap in the AM around 9am. This is just enough to take the edge off and help everyone make it to noon for the nap. Again, if your child will only fall asleep once during the day, this can backfire. See Honest Toddler for the “science” behind this. Please remember that if your child tends to fall asleep in the car anyway, if you are in motion around nap time (noonish), it is very likely that he will fall asleep there and this may be all you get for the day.

Good luck!


Avoiding the perils of an overtired baby

sleepy babyWhen you are a new parent, there are so many things that are new and different then your life was before becoming a parent.  One thing that is very shocking to new parents is how much sleep your child actually needs.  It is also surprising how frequently they need to go to sleep.  When babies become overtired, their brains begin to produce cortisol, which acts as a stimulant in their bodies and actually inhibits sleep.  If you have a newborn, you are probably have already experienced the dreaded “witching hour.” This is often a product of being extra hungry as the day wears on (hopefully storing up on feedings for a longer stretch of sleep at night) and overtiredness creating the perfect storm of crying and hysterics (among both parents and children alike).

Children typically become overtired when they are awake for too long.  Sometimes it can be hard to know what too long really is.  Here is a chart that can be helpful at determining how long your child can be awake before becoming overtired:

0-5 mos 6-8 mos 9-12 mos 12-28 mos 2-4 yrs
Wakefulness window 1-2hrs 1.5-3hrs 2-4hrs 4-6 hrs 5/6-12hrs
Number of naps 4-5/day 3/day 2/day 1-2/day 1 nap/QT
Total daytime sleep Varies 3-3.5hrs 2.5-3hrs 2.25-2.5 hrs 0-2hrs

The other way to know when your child is becoming overtired is by watching their sleepy cues.  Sometimes these are things that are very obvious like eye rubbing, yawning or even ear rubbing (commonly mistaken as a sign of teething or an ear infection).  Other times, sleepy cues can be more subtle like slowing down of play, vocalizing less or when your child is making less eye contact.  Fussiness, crabbiness, irritability or your ability to do anything to make your child happy (as is the case with toddlers) is often a sign that you have missed that window and your child is now overtired.

So you may be wondering why that wakeful window is important or “won’t my child eventually go to sleep even if she is overtired?”  Yes, children will eventually fall asleep, even when overtired, but it often takes longer for them to settle and there is much more crying involved.  In general, it is much harder for children to fall asleep when overtired and they will actually “fight” sleep at this point.  Being overtired for naps leads to shorter naps because when your child is overtired at the beginning of the nap, it makes it harder for her to get through the sleep cycles and stay asleep for her naps.

Trying to figure out when to put your child down for naps and bedtime can often feel like a moving target in the beginning.  As your baby moves towards 4-6 months of age, it can become easier to decipher what he or she is telling you about when it is time to go to sleep.   In the meantime, take heart.  Figuring this out isn’t as easy as it may have once sounded!

A message to Dad, the sleep coaching skeptic

tired-dadEach week I speak to many moms during my free 15 minute phone consultations.  The story is often the same:  it takes hours to get a baby or toddler to sleep at bedtime, there are multiple night wakings, mom is doing a lot of work to try to get said child back to sleep, at some point in the night dad may even try his hand (sometimes with success, sometimes not)—or dad may sleep through the whole thing because he doesn’t hear it or is even sleeping in a different room.  Everyone is exhausted, and if mom is home with her child during the day, she also spends much of the day trying to coax the baby or toddler into one or several naps.  And the process repeats again the next night/day.  It is sort of like the movie Groundhog Day.  It feels never ending and unchanging.  At the end of our call, mom is enthusiastic about the changes we have spoken about and optimistic about the progress she feels her child can make.  She feels relieved to know that help is on the way.  I have given her a realistic picture of what to expect.  She knows that it will be hard work, but at least it feels like there is a light at the end of the sleepless tunnel.  Often we even have scheduled the consultation.  The call often ends with the statement, “I will speak with my husband and get back to you.”  And it ends there.  I either don’t hear back or I get a defeated sounding email a few days later saying that her husband didn’t feel like they needed to spend money on this right now.

I understand that this is a big decision and feels like a leap of faith to put your trust in (in circumstances when you don’t have a personal referral) a virtual stranger who your wife has found in her late night stupor of Googling.  However, there is a reason that your child isn’t sleeping well.  Yes, it is often a puzzle to be put together and figured out step by step.  Sometimes, as the parents in the “thick of it,” it is hard to see all the details and to figure out how to make lasting changes.  Much of child sleep is not intuitive.  Whether you are a new parent or this is your second, third or fourth child, sleep deprivation is painful and impacts your entire family.  Here are just a few of the reasons why hiring a sleep consultant is a good decision for your family:

  • It is okay to ask for help.  At your job, if you needed a problem solved that was outside of your area of expertise, wouldn’t you go to an expert for advice and help with trouble-shooting?  Babies and toddlers present multiple challenges.  I often think of raising a child as a moving target.  As they grow and change, their behaviors (of which sleep is often the most challenging and produces many of the power struggles) change and develop.  Learning how to handle and adapt these changes is what makes being a parent such a tough job.  By hiring a sleep consultant, you are working with someone who is an expert at helping with these very challenging behaviors.  This, in turn, will educate and empower you as you become a better parent.
  • Your partner’s sanity means your sanity.  There are few children’s behaviors that produce more anxiety in moms then sleep.  If your partner sent you this link, it is likely that she is feeling overwhelmed, stressed out and exhausted by your child’s sleep troubles.  With many families I work with, these struggles are starting to take a toll on your relationship with your partner.  Debates and arguments about what to do to fix the problem ensue and sleep deprivation often makes these discussions irrational.  Yes, it is likely that she is more into the idea of hiring me then you are but she wants you to be on board with it.  I strongly encourage both parents to be a part of the consultation so that everyone can be on the same page.  Consistency is the key to success for every family I work with, and there is nothing more inconsistent then parents who are arguing about what Linda did or did not say at 2 in the morning.  Please remember that this has been very hard for her, and this is why she contacted me for help.
  • It’s a great investment.  Teaching your child how to sleep means that you are giving your child a skill that he/she will use for the rest of his/her life.  By investing in your child’s sleep, you are setting them up for success both now and for the future.  This ultimately leads to happier children and a happier family.
  • A trained sleep consultant is the “real deal.”  It’s okay to admit it.  When she said “sleep coach,” there may have been some eye-rolling.  Being a sleep coach doesn’t just mean that I have read a few books and have sleep trained my own children.  Not only am I a licensed clinical social worker with a master’s degree in helping improve family functioning, but I have completed an extensive training and certification program with one of the world’s most well-respected sleep coaches, Kim West.  I am also a part of her advanced program, meaning that I participate in continuing education as well as ongoing weekly case consultation and supervision, which is a tremendous support to the families I work with.  I have done additional training in the area of infant and child mental health as well as newborn sleep development.  There is a reason that families I have worked with are happy to report that their lives are no longer sleepless.  If you would like to speak with someone I have worked with (even a dad!), I can arrange that as well.
  • Brownie points.  You know it.  Happy wife=happy life.  Even if you aren’t 100% convinced, it would go a long way towards showing your wife that you support her.

Still have questions? I am happy to speak with you.  Feel free to contact me so we can set up a time to talk about your concerns.  I realize that this is a financial investment, but it is also an investment in the physical and emotional health of your family.

Why does behavioral fading works when “cry it out” doesn’t?

o-SLEEPING-BABY-facebookMany families come to me after attempting some form of sleep training on their own.  Who can blame them really?  Why would someone pay to hire me when they can do it on themselves?  In most instances, when families have done some sleep training, they have either tried extinction (cry it out/CIO) or graduated extinction and either had no success at all or have seen some progress but then a regression that has landed them back where they started.  After trying these methods, they often realize that they need help and that there might be other ways of going about teaching their child this skill.  Working with families to help them change their children’s sleep is a very individual process and leads me in different directions with almost everyone I come in contact with.  There is not one approach (or one book) that works for all children.  Even after several years and working with hundreds of families, I still can’t say I have worked with any two children who have responded identically to sleep training.  I nearly always present all methods as options to families (I only don’t when a family has up front expressed a desire to use a specific method).  I have, however, seen unbelievable changes when using behavioral fading with children of all ages that I work with(mostly ranging from 6 months to 6 years old).

What is behavioral fading, you may be asking?  This is a method that is often referred to as The Sleep Lady Shuffle, as coined by my fellow licensed clinical social worker and mentor, Kim West.  I will fully admit, until I started using this method with families and understanding all the nuances of it, I wasn’t a believer myself.  The premise of the method is that parents offer a lot of support and comfort to a child in the beginning of the process (both by what interventions they do and their proximity to their child within the room) and then gradually begin to do less and less over the subsequent days to weeks so that their child no longer needs the interventions to fall asleep.  The method uses a parent’s presence as the child’s “secure base” (an attachment term that means that your child feels comforted and secure in learning a new skill because he/she knows a parent is nearby) to help the child learn how to fall asleep independently at bedtime and back to sleep throughout the night.

Behavioral fading offers a consistent and predictable way for parents to respond to their children throughout the whole night.  It also requires that you do respond.   This builds your child’s trust that if he needs something, you will be there.  I frequently hear, “So isn’t this cry it out with me in the room?”  Yes, there will still be crying, but there is a difference in what your child is actually experiencing with attended crying versus unattended crying.  Crying is your child’s way of telling you he is frustrated that you are not doing all the things you did before to do the work of getting him back to sleep.  So often, we are inconsistent when our children wake because we are just trying to survive and to figure out what will be the fastest way to get him to go back to sleep.  By having a plan and knowing what to do at bedtime and for the wake ups, you will be able to be much more consistent and avoid all the pitfalls of intermittently reinforcing the behavior you are trying to end.  This will not be the quick and easy way of getting your child back to sleep in the beginning because it involves your child learning how to do this himself.  Over time, you will see your child start to learn how to go back to sleep and the wake ups will shorten and then disappear.  This takes time, it takes patience and it takes perseverance.   The rewards, however, will be well worth it.

The response I hear most often from families after the first night of sleep coaching is that they are surprised that it was easier then expected and that they felt empowered by the process.  If you have never watched a young child go through the learning process and successfully acquire a new skill, it is truly a sight to see.  Teaching your child how to sleep is something he will use for his entire life.  If you would like help teaching your child this skill, please contact me to schedule a free 15 minute phone consultation to discuss your family’s sleep challenges.