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Baby Sleep – Teething

It so often happens that just when a baby starts to sleep through the night, their sleep gets disrupted by teething. If your baby has teething pain during the night, they will need your care and attention. This doesn’t mean that any sleep progress they have made has to go out of the window.

For most babies, this period of extra need is temporary. You should not feel bad about giving them more attention if they are poorly at night. Realistically, you have little choice in the matter! Babies will not sleep if left in discomfort, and leaving them to cry is not only unkind but also unsafe. It could also lead to them developing an unhappy association with the cot.

Teething is a natural process and not an illness but it can often cause pain and general discomfort. Babies typically cut their first tooth at around 6 months old, but for some, this might not happen until much later. Some babies cut their teeth earlier than this, and some are even born with some teeth.

Teething symptoms

If you are not sure whether your baby is teething, the symptoms are:

  • Red and sore-looking gums.
  • Wanting to chew on everything.
  • Dribbling & drooling.
  • Red cheeks
  • Diarrhoea/loose stools
  • Ear pulling
  • Blocked nose
  • Being generally quite irritable or teary.

Please note that some of these symptoms can be indicators of more serious illnesses, so if your baby has a temperature [above 38C or 100F] or seems very unwell or has a different cry, you should always seek medical advice. 

Not all babies suffer during teething, but many do, and the discomfort of teething is usually much worse during the night when they are laying flat and not chewing or swallowing as much as they do during the day. 

How to help

During the day

Give them lots of opportunities to bite and chew. If they are old enough, encourage them with finger foods. Try crusty bread, bagel and toast which has been allowed to cool and go soft but tough.

Because cold has a numbing effect, keep a teething ring as well as whole peeled or scrubbed carrots in the fridge [never the freezer!] for them to chew on. 

Encourage them to put safe toys etc. into their mouths, as any kind of biting is helpful with teething. 

When babies are teething they tend to drool and this often leads to the skin around the chin and neck becoming very chapped and sore. To help with this, change bibs frequently, or use soft dry muslin cloths. 

After meals and drinks use warm water and soft dry cotton cloths to clean them rather than wipes that might sting. 

Don’t forget to clean and dry the soft skin folds under the chin and neck. Often food and moisture can easily become trapped here. Use a gentle barrier cream here to protect them even further.

Pulling at their ears is often a sign of discomfort and inflammation within the ear. This is common during teething, but to be safe, you will need to visit your GP surgery team. They will establish the cause of the pain and recommend a suitable painkiller if needed.

Babies often have loose bowel movements when they are teething, so make sure that you check and change them regularly. If their bottom gets sore, use plain water for cleaning and a barrier cream.

At bedtime

If your baby is unwell at bedtime, try to follow your normal bedtime routine as closely as possible. Be aware that they may be irritated at being handled. Before bath time give a dose of infant Paracetamol or Ibuprofen if they need it for pain. These medicines will also help to lower your baby’s temperature.

Many parents prefer to give Ibuprofen at bedtime, as it is long-acting but needs to be taken when there is something in baby’s tummy. Then if a second dose of painkiller is needed during the night; give Paracetamol, which is gentler on an emptier stomach. 

Neither Ibuprofen or Paracetamol are sedatives.

If you’re not 100% sure and confident about giving medicine to your baby, speak with a pharmacist, doctor or health visitor.

After bath time, offer a bedtime feed but do not be too worried if your baby refuses it or doesn’t take it all. If they are poorly, they are unlikely to wake up hungry – especially if they are over 6 months old. 

If your baby usually self-settles, you should allow them to go to sleep without help, as usual. Rocking them to sleep when they don’t really need it can become a difficult habit to break once they are better. 

However, if they do need extra cuddles, don’t hold back!

During the night

If your baby wakes in the night and is clearly unwell, you should go to them and pick them up and offer a drink of water [not milk if they’ve already dropped their night feeds.]

This helps to unblock the nose and the tiny tubes connecting the back of the nose to the ears and makes them feel more comfortable. 

If they carry on crying, and/or feel hot, offer a dose of an infant painkiller if it’s needed. If the teething pain has been severe enough to wake them up, gels or granules may not always help.

After your intervention, you can then comfort them until they are calm and settled then put them back in their cot. Try to avoid bringing your baby into bed with you if they are poorly. If you need to stay close, it is much safer for you to go and sleep in their bedroom instead. 

It usually takes two or three consecutive nights of your baby coming into your bed for it to become a habit.

It’s fine to relax the usual rules around bedtime and during the night when babies are teething. As soon as they are better, however, you need to allow them to self-settle again at the start of the night.

Draw back on any new nighttime rituals which may have been needed during teething, but aren’t needed now.

Further help

If you’re struggling with teething or any other sleep-related problem, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

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Reflux & Sleep

Reflux is a condition that is most common in the first six months to one year of life.

What we call ‘reflux’ is actually ‘gastro-oesophageal reflux’ [GORD or GERD in America.]  

The valve between the oesophagus and the stomach* sometimes doesn’t work very well when babies are little. With maturity, however, it becomes more efficient. Usually, reflux gets better after about 6 months. Sometimes, but rarely, it can take a year or a little longer.

*The lower oesophageal sphincter

Reflux is when the contents of a baby’s stomach leak back into their oesophagus (food pipe or gullet) and cause posseting (bringing up small amounts of milk), vomiting and/or burning pain (heartburn) due to the acidity in the stomach. 

Some babies with reflux don’t vomit or posset and this is called “silent reflux.” 

Diagnosis can sometimes be difficult, as reflux is easily confused with colic.

Reflux symptoms

  • Vomiting or posseting [although in “silent” reflux this might not happen.]
  • Crying, especially when they are lying flat.
  • Coughing.
  • Swallowing & gulping.
  • Their vomit and/or breath can smell a little bit sour and acidic because of the acidity in their stomach.
  • Poor weight gain because of not keeping their feeds down.

Cows milk protein allergy

Sometimes reflux is caused by a CMPA [cows milk protein allergy.] This isn’t the case for every baby who has reflux, however. Equally, not all babies who have CMPA have reflux!

CMPA has other symptoms such as skin rashes,  blood in their poo and constipation.

If a baby has a milk allergy, you may be advised to cut dairy from your diet if you are breastfeeding, or if you are formula feeding, your baby will probably be prescribed a special non-dairy feed.

They might also be prescribed medicine to limit their stomach acid production or to neutralise their stomach acid.

Some reflux medicines can cause constipation so you will have to make sure to give them plenty of fluids and if they are taking solids, fibre in the form of fruit & vegetables.

Reflux and sleep

Babies who have had reflux [or colic] in the early weeks, whether simple “mechanical” reflux or caused by CMPA often develop sleep problems later.

The reason is that they have usually needed to be held and comforted to sleep, and now they don’t know any other way.

Whether your baby is still suffering from reflux or is better now but has sleep problems, here are some tips to help them.

Early weeks

  • For the first 3 or 4 months, try not to worry about holding your baby too much or getting into bad habits. You’ll find more information about settling younger babies in my new babies and sleep article.
  • Get a comfortable baby carrier so that you can keep them upright for naps if that helps.
  • After the first few weeks, try to separate feeding from sleeping.
  • Elevate the top of the cot, so that it slopes down at the foot, and place younger babies with their feet at the foot of the cot.
  • Give any prescribed medication in good time for it to work before bedtime.
  • When they are over 3 or 4 months, support them to fall asleep aware that they are in their sleep space. See my guidance on bedtime routines.

Bedtime routine

  • Give their milk about half an hour before bath time and hold them upright. Then by the time they go to bed, the milk should no longer be sitting heavily in their stomach.
  • Follow a familiar and predictable routine, to help them feel safe and secure.
  • Encourage them to settle to sleep aware that they are in the cot, with as little assistance as possible from you. 
  • Follow the principles of good sleeping generally, with a familiar and well-timed routine.

Night feeds

  • Older babies who are over about 7 kg in weight, don’t need a tummy full of milk to see them through the night, so long as they are generally well-fed and hydrated during the day.
  • Drop night feeds as soon as possible, so that they are not struggling to digest unnecessary feeds when they are lying down during the night.

Most importantly, please ask for and accept help from your family & friends. Having a baby with reflux means that your circumstances are special and you will need more support than most parents.

Further help

If you’re struggling with reflux or any sleep issues, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

moving from cot to bed

A step-by-step guide to moving your toddler from the cot to a bed

When is the best time to move a toddler from a cot to a bed?

There is no set time that is right to move a child from their cot to a bed.

Often the decision is prompted by them climbing out, or you need the cot for a new baby.

If your child is ready to come out of nighttime nappies, they will need to move to a bed, so they can use the potty or toilet. 

Most children move out of the cot and into a bed somewhere between the ages of two and three and a half. If they are happy in the cot, it is big enough for them, and they’re still in nappies, there is no reason to move them.

If you are moving your toddler out of the cot to make room for a new baby, leave a few weeks between moving your older one out and the younger one in. 

Making the move

Explain to your child that they are going to sleep in a big bed and let them help you move the cot from the room and put the new bed up.

Or if they are in a cot bed, let them be involved in converting it to a toddler bed. 

Involve them in choosing their bedding and any other bed-related objects such as a cup for their bedside water. Allowing them to take ownership of their new bed will give them positive sleep associations around it.

Make it fun!

During the day, before your child sleeps in the new bed themselves, encourage a game where they put their toys into the new bed. Leave the room and let the toys go to sleep alone. Then praise the toys for lovely sleeping in their bed! Through this little play, they will receive the subtle message that you will be happy if they do the same. 

Other changes you can make

If there are any other changes that you’d like to make, such as getting rid of their dummy or their white noise device, this is your opportunity!

It is also a good time to drop their bedtime bottle if they’re still having one.

A change in environment can help with a behaviour change or a change in routine. If you’ve been used to staying beside them as they fall asleep in their cot, this could be a perfect opportunity to change that!

If they usually wear a sleep bag, you can replace it with a toddler duvet, or sheet and blanket. 

They can also now have a small flat pillow if you like. However, from a physiological point of view they don’t really need one.

Get rid of the cot

Avoid keeping the old cot in their room if you can, as this can cause confusion and night-time bed swapping. If their room is the only space for the cot, fill it with their stuff and use it as a toy box. This is unless the cot is being used for a younger sibling!

Keep everything as simple as possible and don’t give too many choices at night-time. This helps toddlers cut down on bedtime procrastination, tears and delay.

Putting them into their new bed

On the evening of the new bed change, keep up your usual, reassuring bedtime routine before saying goodnight to them just as you normally do. Don’t expect any changes, and if you can demonstrate by your manner that all is as normal, your child is more likely to feel ok about the new bed.

Leave the room on a very positive note, even if they do seem to be a bit unsure, over excited or very wakeful. If they don’t want you to leave, tell them that you will be back very soon to check that they are cosy. Return to them shortly afterwards and praise them for being in bed. [If they are still in it!] Only stay for a few moments before leaving again, “I’m going to wash my hands now [for example] but I’ll be back in a minute.” 

If they get out of bed

If they get out of bed and come to find you, it is very tempting to laugh or hug them, as they will look so cute. But if you do this, they may keep on doing it to get the lovely feedback and entertain you. Quite understandably, they will then be upset and confused when you are no longer finding it funny.

It is better to show them that you are surprised [not angry] that they are up. Quickly and quietly take them back to bed and then, give them the good feedback and praise them warmly. 

Leave again even if they are not happy about it but reassure them that you’ll be back.

If they don’t stay in bed

If they don’t go back to bed, go into their room and close the door behind you. Stand with your back to the door, facing your child. Tell them just once to go to bed and then wait quietly until they move towards the bed. Don’t get sidetracked or involved in any delaying requests. If they ask for more stories/cuddles/food, you can respond with, “We’ll do that/see to that/get that/you can tell me about that…….in the morning.”

It might take them a long time, but they will go back to bed if you wait quietly. Don’t repeat the instruction, but you can say, “I’m waiting, my love.” Then when they show even the slightest signs of going back to bed, praise them warmly. This will encourage them and let them know that you are proud of them. 

 If you’re in a couple, it’s a good idea for both of you if possible to alternate going in and settling/praising them. This is to reinforce the message that even though their bed has changed, the “sleep rules” are the same.

Safety gates

If your child continues to not stay in bed, and you are worried about them wondering about at night, you could fit a safety gate to their bedroom door. Introduce it in a positive manner, “This is your gate, to keep you safe!”

It is better to have a safety gate than closing the door and not letting them get out.

You will also need to have a dim light to keep them safe if they DO wander in the night. Choose one with a red glow which will not limit their sleep hormone [melatonin] production.

If they wake and come to you or call for you during the night, help them back into bed as you did at the beginning of the night. Go to them every few minutes if they are upset.

If they keep getting up or are standing at the gate, take them back to their bed each time. Try not to be in the room as they go to sleep, as this is very likely to become a habit.

It might take them longer to get to sleep

You can expect it to take longer than normal for them to go to sleep, and this is natural because children like things to be predictable and familiar. The changes that you are making may make them unsure and wakeful at first. 

Don’t panic and stay in the room with them to speed things up. If you do this, they will think it needs to happen every night. Unless they are upset, it’s better to let them settle alone, even if it takes a long time.

Once the novelty has worn off, they will be able to fall asleep more quickly.

Praise them in the morning

In the morning, offer them lots of specific praise, for example, “You slept in your big bed!” “You went back to bed when I asked you to!” This will affirm the positive bed/sleep associations for your child.

Further help

If you’re struggling with toddler bedtimes or any other sleep problem, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

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Early Waking Advice

It is normal for babies and young children to wake from time to time during the night, and their sleep is more fragile and broken from about 4 am onwards.

So when your little one wakes up at the crack of dawn or before, don’t presume that something must be wrong.

Early waking can be one of the most tricky sleep problems to tackle, as most little ones are naturally early risers. But there are things that you can do to help them sleep for longer.

1 – Prevent overtiredness

One of the main reasons for babies and children waking up too early is over-tiredness.

Why? Because, when little ones become over-tired, they can produce extra cortisol which is an “awake” hormone.

When dawn approaches, there is a natural drop in melatonin [sleep hormone] levels and a rise in cortisol. Then because of the cortisol already in their system when they fall asleep, the process of melatonin/cortisol crossover can happen too soon.

You can help avoid over-tiredness by extending the day time nap[s] or putting them to bed a bit earlier – which may sound a bit counterintuitive but works for lots of little ones!

2 – Avoid dawn rituals

Does your baby or child come into your bed at dawn?

Do they have a bottle or breastfeed before getting up for the day?

Perhaps you go and lie next to their bed or cot etc. at dawn?

If any of these things are happening, your little one may be waking early expecting this ritual to happen. They may even wake earlier in the night looking for their ritual.

Once they are old enough to go through the night without a feed, give their morning milk in the living room. Make sure you’ve opened their curtains and said good morning first. These are very important daytime signifiers.

If you want to bring them to your bed for their morning milk and cuddle, open your curtains beforehand. When they come to you in the dark and you’re lying there trying to sleep, they will think it’s nighttime.

It is good to keep them in their own bed or cot until morning and give them a reassuring but minimal response when they wake either during the night or at dawn.

3 – Give the right response when they wake up early

When your baby or child wakes very early, leave them alone if they are not upset. They may just be taking time to transition to their next sleep cycle.

As dawn approaches, falling back to sleep can sometimes take an hour or more. As long as they are not upset, and you’re confident that they are safe and well, you can give them as long as they need.

If your little one is crying or calling for you, it’s not good to leave them. It’s possible that they won’t manage to go back to sleep, and this is not a good start to the day. It is far better to go to them before they become upset and tell or indicate that it is still sleep time. 

Then you can either remain beside them or keep popping in and out to them until they either go back to sleep or until you reach an acceptable getting up time. 

Giving them a feed, cuddling them back to sleep or bringing them into your bed etc. might help in the short term, but longer term, it might reinforce the early waking.

When you first start to keep your baby or child in their bed when they wake early, they might not go back to sleep. You will be merely teaching them that when they wake it doesn’t necessarily mean that they get up. Over time, though, when they learn to remain in their bed/cot, they will have a much better chance of going back to sleep.

If they have managed to go back to sleep after an early wake-up, it’s best to gently get them up an hour or so later. This is to keep them on a reasonable daytime schedule.

4 – Manage their naps

Avoid a very early or long morning nap, as getting into a pattern like this can “secure” or enable early waking to continue

Give them an early cat nap of about 15 minutes if they are struggling to stay awake in the early morning. , Keep in mind, however, that when babies are more than a few months old, good napping later in the morning, at midday or in the afternoon encourages better nighttime and early morning sleep.

Younger babies need a late afternoon nap, usually a short one to see them through to bedtime without becoming over-tired.

Check out the chart below and make sure that your child is getting enough [but not too much] daytime sleep.

5 – Give them time clues

Little ones have no sense of how long they’ve been asleep and how close it is to morning. They need you to provide these time clues. You can do this by offering them daytime and nighttime signifiers, such as darkness at bedtime and light in the morning.

Change your voice to a low and soothing tone when you want them to sleep and a brighter tone when it’s wake time.

In the morning, open the curtains, and if it’s still dark outside, put the light on too before you get them out of the cot. This will give them a visual prompt/signifier that it is now getting up time. 

If you do this every morning, they will soon come to realise that when the curtains are closed it means that it is sleep time. If at the beginning of the night, you make closing the curtains before they go into the cot part of the settling routine, you will further reinforce this message.

These visual time clues and routines are very important for babies, who obviously are not yet able to tell the time.

Over twos can be helped to recognise when it’s getting up time by the use of sleep training clocks/lights.

Sleep clock rules

Choose one that has a red or orange glow. Some sleep training clocks have a blue back light, which interferes with melatonin production.

Set the clock to “wake up” at a time just a few minutes after your child’s natural wake-up time, even if this is very early.

Then gradually move the time forward as your child understands the principle of waiting in their bed. If they learn to wait in their bed, they have the opportunity to fall back to sleep.

With a very young child, there is no need to explain the principle of how the clock works. They will learn it by experience.

You must obey the clock if you expect your child to! It’s no good setting it for 7 am and then getting your child up before then, while the clock is in sleep mode. If you do this, they will learn that waiting for the clock to wake up is optional.

Don’t let your child play with the clock! They may alter the wake-up time – which defeats the object!

Always praise your child for waiting for the clock to wake up.

6 – Get their sleep space right

Keep your child’s sleep space as dark as possible, as this helps them to keep producing sleep hormones. If you need a night light, use a red one, as this is more melatonin-friendly.

During sleep, the body temperature drops, slightly and this is a natural part of sleep. If a baby or child is kept too hot at sleep time, they will not sleep as well. It is also important from a safety point of view that their room is kept at a cool 16 – 20 degrees centigrade.

Here’s a guide to help you keep your little one cool and comfortable. 

7 – Build up your child’s general sleep skills

If your child is an early waker and is also struggling with settling at bedtime and waking during the night, you need to work on building better skills overall. You can do this by helping them fall asleep as independently as possible at bedtime. This is the time when they’re full of sleep hormones and they have a lovely build-up of sleep pressure.

Often, the key to solving early waking lies in how a child falls asleep at bedtime.

Sleep cycles get lighter and more broken as morning approaches and unless a baby or child has well-practised and secure sleeping skills, they can struggle to join these lighter sleep cycles.

If they wake up too early and can’t resettle, they miss the final one or two sleep cycles of the night. This isn’t because they’ve had enough sleep but because they don’t know how to get themselves back to sleep.

So if you’re rocking, nursing or sitting with them as they go to sleep at bedtime, you may be preventing them from learning these essential sleep skills.

My Gentle Sleep Course can help you get your baby or toddler to improve their sleeping, whether they have a simple early waking difficulty or difficulties with sleep generally.

Your own sleep matters

Early waking in babies and young children is a phase that most of them go through and it will pass.

Whilst it’s happening, you need to go to bed as early as possible. If you’re in a couple, share the early starts.

You need sleep so that you’ve got the energy to deal with this phase and also to protect your own mental and physical health.

Further Help

If you’re struggling with early waking or any other sleep problem, I am here to help you.

My Books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

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Coming out of nappies at night

Night-time dryness comes after a child is toilet trained during the day. Often there is a considerable period in between before they will be dry at night.

Only look towards helping your child to become dry at night when they are reliably dry during the day. As a rule, most children are daytime toilet trained by the time they are 3 years old, but many are older.

Signal from the brain

To be dry at night, children need to receive a signal from the brain to let them know their bladder is full. It can take a while for them to get the hang of reading and responding to that signal. This is especially the case when they are asleep and it is not at all unusual for a four- or five-year-old to still be in night-time nappies.

Vasopressin

Vasopressin is a hormone that reduces urine production at night. It is produced in the Pituitary gland and levels of this hormone increase with age from birth. Until its action kicks in your child might not be ready to come out of their nighttime nappy. 

If your child has a very wet nappy in the morning and is no longer taking a night bottle, it is a sign that they might not yet be producing enough vasopressin. If they are over five years old, your GP practice, school nurse or health visitor will be able to advise you.

Help them with nighttime bladder control

•   Offer them plenty of fluids during the day. 

•   Stop them from having a drink an hour before bedtime

•   Drop feeds or big drinks during the night.

Are they confident with using the potty or toilet during the day and have dry or nearly dry nappies fairly consistently in the morning? If so, you can take this as a signal that it is time to start night-time potty/toilet training.

Make a start

Helping your child to become dry at night is more effective if you keep the whole process as relaxed as possible. Suggest that they might like to have a go at sleeping without a nappy. Make sure that you have a waterproof mattress cover on their bed. Then encourage them to use the toilet before they go to sleep. Don’t make a big deal about it or over-pressurise them, however. 

Should I ‘lift’ them?

Many parents choose to lift their children and put them on the toilet later in the evening, just before they go to bed themselves when the child is asleep. Nowadays this isn’t considered to be a good idea, as the child doesn’t learn about bladder control, and it just teaches them to wee in their sleep. 

From a sleep point of view, it is not good to disrupt that very special and precious deep sleep that happens at the start of the night, either, and there is also the risk that rousing a child out of deep sleep can cause distress and confusion.

If they wet their bed

If your child wets their bed, try to remain calm. Quickly change the sheets and their nightclothes if they have woken up. Then encourage them to go to the toilet to see if they have any more wee left. After this, re-settle them to sleep. 

Let them know it’s okay, it’s not their fault and you’re not cross. 

If your child manages a dry night, praise them gently but don’t overdo it, or they might feel they’ve let you down if they wet their bed next time.

Do not use a reward chart, as this is not something that is entirely within their control. You can, however, praise them for the things that they have done to help themselves achieve dry beds. Examples would be waiting until morning to have a drink or going to the toilet when you ask them to, and so on.

Night-time toilet training tips [once your child is dry during the day]

1. Encourage them to drink enough during the day [6-8 glasses.] No fizzy or caffeine-rich drinks. Restricting daytime fluids can cause the bladder to be less efficient.

2. If you are still giving a bedtime bottle, now is the time to drop it. If your child is well hydrated during the day, a big drink at bedtime or during the night [unless they are unwell or it is very hot] is not necessary. 

3. Do not allow your child to get constipated, as this can affect bladder function.

4. Use waterproof easily changeable protection on the bed to minimize night-time disruption.

5. Use the toilet just before bedtime.

6. Leave a soft light on and if the toilet is not easily accessible, have a potty in their room.

7. If your child wets the bed and wakes up, praise them for telling you and still take them to the toilet to see if they can do a bit more.

8. Praise them gently but warmly when they manage a dry bed and don’t expect this to be every night at first.

9. Expect just the occasional dry night at the first few attempts.

10. If your child doesn’t manage a dry bed after 3 – 4 weeks of trying, give up and try again a few weeks later. Or wait until they start to have dry-ish nappies in the morning. 

Further help

If you’re struggling with any aspect of your toddler’s sleep, I am here to help you.

My book

Book by baby sleep expert

My bestselling toddler sleep book gives you the tools to help your child and yourself get a good night’s sleep. It is full of expert, practical advice and case studies. The book teaches you to create your child’s personal sleep plan and is written in a clear and accessible style.

It is available in all formats from Amazon and other booksellers.

My Early Waking Course

If your toddler is up before the milkman, you may find this course helpful. The Early Waking Course includes information about sleep training clocks, napping advice and techniques to prevent and deal with early waking. It takes around an hour to complete and it may be the best hour you’ve ever spent!

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

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The four-month sleep regression

Somewhere between about 3 and 6 months, some babies start to wake up more during the night.

Welcome to the “four-month sleep regression!”

The regression happens after a period when your baby might have started sleeping for longer stretches during the night.

Suddenly they start to wake more frequently and sometimes to feed more frequently too

Sleep advantages that are happening now

  • They are establishing mature sleep cycles and experiencing deeper sleep
  • They are making their own sleep hormones
  • They are bigger and need less milk at night

Sleep cycles

Around this time, babies settle into a mature pattern of sleep cycles – with light sleep, deep sleep and waking phases. Each sleep cycle lasts about an hour.

This means that they wake up during the night as they go through these sleep cycles.

Sleep hormones

Your baby is now producing their own sleep hormones, such as melatonin. Previously for night time sleep, they relied upon being close to their parent – sharing their circadian rhythm.

Getting bigger

Young babies need to feed regularly, including during the night. They are growing very rapidly and their little tummies can’t hold enough milk to sustain them for long.

At around this age, their rapid growth settles into a slower and steadier weight gain. Many babies of 4 months have the body weight to enable them to sleep for stretches of 5 hours or more at night without getting hungry. 

So given that all this positive stuff is going on, it can be frustrating when babies start to go backwards with their sleeping!

Why does this happen? 

It is because also between 3 and 6 months, babies become more conscious of what is going on.

They start to figure things out and make learning connections. 

These connections, made as they fall asleep, can develop into expectations and preferences around their night sleeping and napping. In other words – habits are formed.

So as an example – if they are fed or cuddled to sleep at the start of the night, they may need or expect those same “sleep triggers” when they wake up naturally after a sleep cycle.

Of course, it is fine to cuddle or feed your baby to sleep if that’s what feels right for you or if that’s what they need. Be aware though that if at this age, they start to wake for feeds and cuddles more than they used to; there is a good chance that they are doing out it of habit rather than need.

This can be disruptive to their sleep and yours also. 

How to deal with it

A good bedtime routine really comes into its own now. You need a repeated series of steps leading up to bedtime that baby will recognise as sleep cues. 

Then unless you’ve chosen to co-sleep, it’s good to help them fall asleep in the cot aware of where they are. A lovely way of doing this is to give the last feed with the light on and follow it with a simple book. Then lights off and put them down into the cot awake. Soothe them there if they don’t like to be left, or leave them to self-settle if they’re ok with that. 

As sleep now happens in cycles; it is normal to wake a few times in their sleep. When your baby wakes up, they will need to have everything around them, the same as it was when they fell asleep. 

So the more independently they fall asleep at the start of sleep, the more likely they are to be able to join their sleep cycles by themselves. 

If they do wake up, try soothing them in the cot for a while rather than automatically picking them up or feeding them. They might just resettle and drift back off, but of course, if they continue to cry, it is best to respond with whatever feeding or cuddling they need. 

Watch out that they don’t feed so much at night that they have no appetite for feeds during the day. This is such a common situation and is called reverse cycling. If your baby feeds a lot during the night you might find that they feed distractedly during the day. You may be constantly trying to tempt them or persuade them to feed during the day! As soon as it is dark and quiet, they will take good sustained feeds. Soon it becomes an established feeding pattern; one that can be difficult to break away from. How can you possibly stop the night feeds if these are the only ones your baby takes?

If you WAIT for your baby’s daytime appetite to improve before reducing night feeds, you’ll be waiting forever! The way to approach this is to cut down on the night feeds and then you’ll find that the daytime feeds will gradually increase.

Will this regression pass by itself?

For some babies, this is a phase and it will pass. For others, the habits which form during the period of regression can stick, meaning that their wakeful nights become the norm. If you’re struggling, you’ll find more help to establish good sleep habits in my Gentle Sleep Course and also in my book, Gentle Sleep Solutions.

Does every baby go through the four-month sleep regression?

No! Many babies naturally sleep for longer periods as they get bigger and older. This is especially true of babies who have a naturally very calm disposition and find it easy to settle to sleep without much help.

In my experience, babies who do go through this regression are usually very alert, engaged and quick on the uptake!

Further Help

If you’re struggling with the four-month or any other sleep regression, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot

bedtime routine pic

A great bedtime routine to help your baby sleep through the night

When they are newborn

It takes around 6 – 8 weeks for a baby to begin to get their days and nights sorted out. After this time they usually begin to sleep for longer periods during the night.

There are 7 keys things that you can do to help them along with this process:

1 – Feed them on demand. Babies are more settled with a full tummy and lots of cuddles.

2- “Cluster feed” in the evening. This means giving lots of feeds close together. The reason this helps is that in the evening, breast milk contains raised levels of Tryptophan.  Tryptophan is an amino acid which converts to a sleep hormone!

3- Allow them to experience the difference between nighttime and daylight. This encourages the production of nighttime sleep hormones and helps to set your baby’s circadian clock.

4- Wind them well after the final feed. Hold them upright and use deep, circular strokes to the base of their back. This works better than tapping their upper back.

5 – Introduce a bedtime song or poem which will become a sleep association. Spoken or sung cues are lovely portable elements associated with sleep.

6 – Try whenever possible to put them into the cot relaxed but still awake. It’s important that when they wake later, they don’t feel confused about no longer being in your arms. 

7 – At around 6-8 weeks, when your baby starts doing longer stretches of sleep at night time, introduce a lovely consistent bedtime routine. 

What is a bedtime routine?

The best bedtime routines provide a familiar series of steps leading up to them going to sleep. 

Each of these steps will in time become a mini sleep trigger for your baby. 

The routine can be short and sweet, or a bit longer – providing that it works for you and is consistent. 

The best time to begin the routine is when you know that they are nearly ready to sleep. 

The process of the routine is more important than the time at which it is carried out. So if they’ve slept late in the afternoon, you’ll need to start the routine later. Putting a baby to bed with lots of energy to spare is likely to result in crying and calling for you. It can also result in them developing negative associations with bedtime.

Equally, try avoid your baby from being over tired at bedtime. When this happens, they can struggle to settle, as they become stressed.

Here’s the perfect routine!

Don’t start too early! Half an hour before the expected sleep time is enough

Turn the TV or radio off. Put on soft music or just have quietness. Put your phone away.

Take everything that you need for the night with you, to avoid having to come back into the living room.

Follow a similar bedtime “script” by using familiar phrases and actions during the routine.

Bath them every night if you can. If you can’t, still try to have a washing “ritual” each night.

Go directly to the room that your baby sleeps in from the bathroom.

Dress them for bed – don’t worry if they’re wriggly & cross – they usually are at this time!

Give the final feed in the bedroom and don’t let them fall asleep on it.

Keep the light on or curtains open to prevent this

Don’t give them their bottle in their cot.

After the milk, look at a book together – sitting on your knee rather than in their cot.

Put them into their cot whilst they are fully awake.

Kiss them goodnight and then teach them how to fall asleep – knowing that now they are naturally ready to do it!

Other ways to promote good sleep

Many sleep problems are caused by babies being rocked or fed to sleep. 

When babies wake up later, during a natural sleep cycle, they are understandably upset to be in a different place. 

Most parents react by picking their baby up and rocking or feeding back to sleep again. 

Remember: you cannot prevent your baby from waking in the night. What you can do is to teach them to feel comfortable in their cot and to settle back down. 

The best way to do this is to put them down awake at the start of the night. Then leave them to self-settle if they’re ok with that. If they’re not, stay beside them using patting/stroking/kind words/singing etc. until they eventually settle. Give them as long as they need.

From about 2-3 months, they have a build-up of their internal sleep hormone [melatonin] towards the end of the day. 

They also have a natural build-up of “sleep pressure,” which comes from how long they’ve been awake.  

These important factors mean that babies are biologically programmed to sleep at the end of the day. 

Don’t break the sleep pressure by letting them get too drowsy in your arms before putting them in the cot and they will soon go to sleep. Just give them time and don’t lose your confidence.

Further help

If you’re struggling with your baby’s sleep or have any questions, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness.

As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot