The Tot Q&A: Newborn Sleep

Tot Expert and certified child sleep consultant, Mary Cantwell, of Rest to your Nest answers 20 questions related to newborn sleep and how to lay a foundation for healthy sleep for life.

Q: My son is 4 months old. Some nights he will sleep through the night but mostly he wakes up to feed but does not finish his milk (he’s bottle fed breastmilk – 4oz) and then goes back to sleep again. Any advice to get him sleep throughout the night consistently?
A: You have yourself a pretty good sleeper!  Our children are born with an immature circadian rhythm and as they reach 4 months, this sleep rhythm has matured enough where they can connect their sleep cycles independently and consistently. At his age he might still need that occasional night bottle for nutritional purposes. Check with your pediatrician about when you can stop the overnight feeds based off your child’s health history/age. Once you get the go ahead, decrease the amount of ounces over time and when you’re down to last ounce, then you can transition over to no feedings. If you are consistent with your response when he wakes at night then he should move through this phase within a week or so. Good luck!

Q: Any tips for helping a baby transfer sleep cycles? My two month old almost always wakes at the 45 minute mark during the day.
A: You are at the half way mark to where your child’s circadian rhythm will be completely mature enough to connect these cycles independently. So hand in there! You will notice your baby’s night time sleep begin to elongate first, then the morning naps and finally, the afternoon naps. A young baby’s sleep cycle is 45 minutes (hence why they wake up every 30/45 minutes). When they wake up, we want to give them the opportunity to try to put themselves back to sleep, connect their sleep cycle and practice self-soothing. When they wake, go on in to pat their bottom or rub their back briefly and walk back out to see if they can complete the transfer to the next sleep cycle. Try to do this for at least a couple of minutes to see if they can settle themselves back to sleep. If they can’t, go in, pick them up to try to get them to go back to sleep, by rocking, shushing the – whichever method works best for you.  Be sure to keep the room as dark as possible (use blackout shades), use a white noise machine and use minimal talking/interaction so that we set the tone early that it’s sleep time. Remember we can’t create poor sleep habits at this age so don’t fret about it too much. What you can do is help lay that foundation for good sleep hygiene!

Q: My baby is 6 weeks old. He does great until about 1 AM, and is then up almost every hour. He only nurses for about 5-10 min on a single breast after that, but it is hourly. Any way to decrease his waking up during this time?
A: The first part of the night is when their deepest sleep occurs, so sleep is the most consolidated typically until 12:00pm/1:00am.  During the times that he wakes up, keep the room as dark as possible (blackout shades are prefect for this!) to promote the production of melatonin. Use a white noise machine and feed him with minimal interaction. If you need a night light to feed, be sure to use one with a red or orange hue since it promotes the production of melatonin. Once fed, settle him a bit and then place him back in the crib drowsy but awake.  Over the next few weeks you will see this middle of the night waking naturally decrease as they mature on the sleep front. Hang in their mama!

Q: My 3 week old son sleeps well during the day, but has trouble falling asleep starting from around 8pm till 2-3am. He needs to be held and breastfed constantly. Any ideas on how to change this situation?
A: In the first 6 to 8 weeks our littles ones have complete day and night confusion. Don’t fret over creating poor habits at this time. Do whatever it takes to promote sleep (such as rocking, holding and so on) for the baby!  We want to make sure we keep them rested and not overtired which makes it harder for them to fall asleep and stay asleep.  As he gets closer to the 6-8 week mark, you will see him begin to sort out his day and night confusion which means a gradual switch from a lot of day sleeps to more sleep during the night.

Q I have an 8 week old that is sleeping pretty well at night (we have a snoo) but will only take his day time naps in a sling or carrier. He won’t nap in snoo, swing, stroller or even my arms. He falls right asleep though in carrier or sling for hours ( as long as I stay standing up – makes for very long days) Also won’t take pacifier. Any suggestions?
A: Hang in there! He is rounding the corner where his day sleep will start coming in like his night sleep did. The first nap of the day is typically the easiest since it’s an extension of our night sleep. I would start with this first nap in the Snoo or Crib since it seems to be the one where he falls asleep most easily. Over the next few weeks, start adding another nap in for a few days and before you know it all the naps will be in the crib soon enough! Good luck!

Q: Our 14 month old is transitioning from two to one naps, any tips?
A: The transition from 2 to 1 naps ranges between 13-18 months of age but the average age is 15 months.  So your child right on schedule!  I recommend moving that morning nap start time to 10:30 and then moving it back 15 minutes every few days until you get to between 12:30/1:00pm which is where this nap will take place once the transition has successfully occurred. You will notice that your child will be ready for bedtime a bit earlier than normal as they move through this transition. This nap transition is gradual and can take a few weeks to a month so be patient, keep an eye on their sleepy cues (rubbing eyes, staring into space, tugging on their ears and so on) for bedtime so that we make sure that they are well rested and not overtired.

Q: My 6 month old son very loudly “talks” in his sleep. He’s been doing it off and on since he was a newborn but now it happens multiple times a night. It’s very adorable and it sounds like he’s singing to himself but it wakes me up. I usually sneak a pacifier in his mouth to quiet him so I can go back to sleep. Any other ideas? I won’t feel comfortable turning off the baby monitor.
A: Oh my goodness those conversations must be adorable!  Some kids do sleep talk at night especially if they are a bit overtired. I would look at putting him to bed even 15/20 minutes earlier to see if the sleep talking decreases.  If it does, you know he just needed to catch up on some rest and it typically works itself out within a week or so.  Cheers to sleep!

Q: Any tips for weaning out of Merlin’s Magic sleep suit? My 5 month old was sleeping so well but now is flipping over in it. We’ve tried sleep sacks but being ‘free’ turns into playtime and not being able to sleep.
A: Once your little one starts flipping over, scooting around or trying to break out of it, then it’s time to switch to the sleep sack. Be sure to also have him in light pajamas underneath the sleep sack. This will be a new way for him/her to fall sleep so I suggest moving up bedtime up by 15/20 minutes since it will take them additional time to fall asleep.  Over the next week or two, the novelty of the sleep sack will wear off and they will go back to sleep like they once did. Good luck!

Q: I’m struggling to get my 3 month old on any semblance of a schedule. I’m not trying to do anything hardcore, but I am looking for some element of predictability. She doesn’t nap for longer than 40 minutes unless I nurse her back to sleep, and we try for bed around 7pm. She wakes an average of 2 times per night, though sometimes it’s as many as 4 and we are exclusively breastfed.
A: You have the right attitude about getting her on schedule and it sounds like that overall, her nights are pretty good! First and foremost, you want to make sure her room is conducive to sleep and that all sleep (day and night) is consistently taking place in the same space. To help promote optimal sleep and melatonin production, you want the room to be cool (68-72 degrees) and dark (blackout shades behind curtains or blinds are a must!). I would also have a sleep routine in place for her for day and night sleeps so that it becomes a signal for her to sleep.  We want to be mindful of awake times during the day (between 1 to 1.5 hours for her age) and keep an eye on her sleepy cues so you lay her down before she becomes overtired which makes it harder for her to fall asleep and stay asleep longer. If she wakes from a small nap, give her a few minutes to try to put herself back to sleep. If she can’t, step in and do what you can to have her fall back to sleep. She is almost 4 months old which is when the circadian rhythms are fully mature and she will soon be capable of learning how to connect those sleep cycles independently. Good luck!

Q: Any advice on how to get a 5 month old to sleep past 5am? He goes down around 7:30pm wakes once to eat (I’m currently weaning him from his night feeding in hopes he’s sleeps straight through the night soon.
A:
At 5 months old, they are on average 14 hours of sleep per day. This is typically 11 to 12 hours at night and 3 to 4 hours during the day. We want to make sure that your child is getting on average this amount of sleep overall so that he stays well rested which will help him to stay asleep for longer periods of time.  I am sure you have heard the old adage ‘sleep begets sleep’ and it is so true! The more sleep he gets, the longer he will sleep at night. Good luck!

Q: Our 3.5 month old was a great night sleeper from a few weeks on – nursing to sleep at 8:30pm and sleeping until 5:00am, waking to nurse in bed with me until 7:00am. We took her out of her swaddle as she’s able to roll over and she’s waking up almost every single hour. It’s a complete change and when she wakes up she is not able to get back to sleep – screaming and gets more upset than any other time.
A: You are spot on with removing the swaddle once she started rolling. If her startle reflex is still high then you might want to look at a transitioning solution such as the Merlin Sleepsuit. If her reflex is not very high then go ahead and get rid of the swaddle but do it gradually over a week. The way to do this is to swaddle her with one arm in the swaddle and the other out over a few days and then do the other arm over the next few days. Good luck!

Q: We’ve co-slept with our daughter who is turning 1 this weekend and she breastfeeds to fall asleep which means it’s only me who can get her down. When we’ve attempted a bottle, it only upsets the situation as it’s not breast. She reliably sleeps through the nights and keeps to her nap schedule but the tradeoff is that they exclusively involve me in the process. It’s been a wonderful first year but I’d like to start working towards a nap and bedtime routine in her crib.
A:
Happy Birthday to your little one!  For my families that have co slept in combination with breastfeeding, we would take a more gradual approach since they are learning their new sleep skill of sleeping independently in conjunction with a new sleep environment. You can start with the tiny step of moving up nursing in the bedtime routine so that it is not the last thing she does before falling asleep.  I have worked with many families that have made this exact same transition and made it with much success. You are at a great age for her to be able to make that transition.  If I may serve your family on this sleep journey, feel free to book a complimentary 15-minute sleep evaluation. Just DM me for the details. Look forward to chatting!

Q: Is there any method that doesn’t involve crying?
A:
This is a great question and one that sleep consultants get often!  In my sleep consulting practice, I utilize multiple methods from direct to semi-gradual to gradual.  I work closely with the family on what is the best option for them based off the child’s age, personality and the family’s lifestyle and philosophy.  Sleep is a learned behavior so your child would be learning a completely new skill. The way our children communicate at a young age to let you know that they are aware something has changed in their routine is to cry. We do have methods that are super gradual so you are with them to guide them as they learn their sleep skill.  If you would like more details, feel free to DM me to book a complimentary 15-minute sleep evaluation session. I’ll be able to answer any questions you have and get more details on what’s happening sleep wise. Cheers to sleep!

Q: When to start sleep training?
A:
Great question!  Our children’s circadian rhythm, which is what regulates sleep, is not fully mature until 4 months of age.  We need to take into account that if your child was born early then we should go by their adjusted age. For example, if they are chronologically 4 months old but they were born a month early, their adjusted age is 3 months old. In this instance, we would wait until the adjusted age of 4 months.  Hope this helps! If I may be of service to your family, feel free to DM me and book a complimentary 15-minute sleep evaluation so I may answer any other questions you have.

Q: We have an 8 week old who is (luckily) a pretty good sleeper—4-5 naps per day and sleeps at night from 8pm-6am with one wake-up. However, he is terrible at self soothing and getting himself to sleep. When should he be able to fall asleep on his own aka, not rocked to sleep in my arms? And how do we make that transition?
A: You sure do have a pretty good sleeper on your hands!  At this age, we want to give him the opportunity to try to self soothe if he wakes during the night or wakes from a short nap. To help him practice this skill, when you lay him down, give him a moment to try to settle himself.  If he can’t, go on over and pat/rub him or gently shush him to try settle and then give him a moment to try to fall asleep. If after a few minutes he can’t seem to do this, pick him up and rock him to sleep.  He is at a nice age where he can’t yet form poor sleep habits and he will also slowly learn the ability to self soothe.  Be patient and practice consistently with him!

Q: I have a 2 year old that doesn’t want to sleep in her bed. She cries if we leave her and gets hysterical and vomits. I have done everything: routine, have her fall asleep in my arms, etc etc but when she realizes she is in her bed, she cries and vomits!
A:
Self soothing comes in many forms but the ones you don’t hear much about is head banging and vomiting.  When I’ve worked with children who were doing this, the family would choose the method that best aligns with their philosophy and lifestyle and I’d lovingly work with them while they’d learn their new sleep skill. I would be there with their child if, and, when they’d be in danger of vomiting. We’d make sure that we’d have an arsenal of extra towels, bedsheets, and pajamas on hand to make clean up easier and quicker. If the child did vomit, we’d enter the room quietly in the dark, replace the soiled sheets, wipe/clean the little one up with a wet wash cloth and calmly place them back into the crib.  They key thing is to try to stay as calm as possible and make it a non-event that we are changing the sheets.  Typically, this behavior would work itself out with my families over 2 to 3 days. If I may be of service, please DM me and reach out!

Q: My two month old is not a big napper. She hardly sleeps during the day, if I can get her to sleep it’s usually only for 30 minutes. She goes to bed around 8:00-9:00 pm at night and sleeps until 6:30 am, sometimes waking 2 or 3 times per night. Do you have any advice for her to sleep better during daytime or wake up less at night? We do swaddle her, use white noise, rock her? We tried a pacifier but she doesn’t want it. I’m exhausted taking care of her constantly without many breaks during daytime.
A:
At 8 weeks of age, you’ll start to see longer periods of sleep at night which she is right on track for!  The day sleep starts showing some elongation and consistency once you get closer to 4 months of age.  What you can do now is to be aware of her wake times (45 mins to an hour), watch her sleepy cues (rubbing eyes, staring into space, pulling on ears and so on) so that you put her down to sleep before she becomes overtired which will help her fall asleep and stay asleep longer.  Also, make sure you are placing her to sleep in the same place consistently, have a brief wind down routine and that the room is cool (68-72 degrees) and dark. You will see the morning naps happen first and then the afternoon naps.  Once these start consistently happening, the night sleep will get better as well.

Q: My 19 mo old is still in our bedroom in her crib. She usually wakes up (cry’s) once per night and wants to sleep in our bed. I put her in our bed till she falls asleep then back in her crib she goes. How do I stop this?
A:
I would set up a partition in your room to separate the section that she sleeps in so that it becomes like her own room. Be sure that it is far enough away from her and secured so that she can’t get to it and pull it down on top of herself. When she wakes up in the night and sees you, she doesn’t understand why she can’t hang out with you all in bed. Hanging out with you is way more fun that sleeping! It typically takes a few days for kids to get used to the partition but once she does she will start sleeping more soundly at night.  Good luck!

Q: I have a six week old who can’t be put down to sleep! She regularly sleeps for 2-4 hours either in our arms, in a boppy in my lap after she’s nursed, or on my chest (this is the only way I get some sleep at night!). I also have a 22 month old so I need to get this figured out before my husband returns to work in a couple weeks and I don’t have the luxury of letting my newborn sleep on me. We’ve tried: swing, rock and play, dock a tot, and bassinet (we’ve tried putting her down when she’s already asleep, sometimes swaddled, sometimes not). A couple times I’ve let her sleep tummy down on our bed while I watched. Should we be trying more? Harder? We plan to sleep train and 3 or 4 months but I can’t hold her all this time. In case it matters: she’s EBF and nursing well (she was almost 11 pounds at her 1 month checkup). I don’t believe she has reflux because she doesn’t spit up regularly – I suppose it could be “silent reflux” but I just think she doesn’t like being put on her back! Thank you!
A: You all are doing the best you can do right now!  It’s hard to say without knowing enough about her medical history but I would reach out to her pediatrician and voice your concerns about possible reflux.  We sometimes don’t know if it’s reflux or not especially if she’s not spitting up (aka silent reflux).  At this age, the Moro reflex is still high so maintaining a swaddle is good idea and for utmost safety we always place her on her back to sleep.  Once you can rule out reflux, then we will have a clearer picture on how to help her sleep wise. Keep in mind that she is only 6 weeks old and daytime sleep is not consistent just yet.  Be consistent with where she sleeps, keep it dark and cool (68-72 degrees to help with melatonin production), be aware of her wake times and as she matures her in circadian sleep rhythms you will see naps starting to consolidate a bit.  Good luck!

Q: Can I sleep train an 11-month-old? And what are some good strategies.
A:
You absolutely can!  I always recommend waiting until at least 4 months of age when their circadian sleep rhythms are mature to learn to sleep and connect their sleep cycles independently. There are multiple methods from direct, semi-gradual to gradual that we work with to help our kiddos learn their sleep skills.  Feel free to DM me to book a 15-minute complimentary sleep evaluation so I may answer any questions you have.  Look forward to chatting!