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Caring for your baby at night when they are unwell

Babies tend to have, on average, about six to twelve minor illnesses such as viruses, colds and tummy upsets each year.

……and that’s not even including teething!

After the age of 6 months, when they have lost the immunity given by their mother, it is not unusual for babies to catch some kind of virus every few weeks.

This is especially the case if they are in daycare or have an older sibling that is.

Exposure to antigens in young childhood builds up their immune system and so, even though these illnesses can be tough at the time to cope with, they do actually make your baby’s resistance to infections stronger in the long run.

A guide for when they have a virus/infection and are generally poorly

Give them a painkiller if needed, about 20 minutes before their bath. Ibuprofen is a good choice, as it needs to be taken with food. Then if another painkiller is needed during the night, you can give Paracetamol, which can be taken without food and is a different “family” of painkillers.

Bathe them if they are well enough and then dress them quickly and take them through to their sleep space.

After their bath time, offer their usual milk feed. 

Don’t be too stressed if your baby refuses their usual milk or doesn’t take it all. If they are poorly, they are very unlikely to wake up hungry, even if they haven’t eaten much during the day. Their body needs to rest and repair at nighttime, and if they have lost their appetite, they will soon regain it and catch up with any lost calories when they are better. 

If your baby usually self-settles, allow them to go to sleep without help, as usual. It’s fine to return frequently to them to check and reassure them, but rocking them to sleep can become a difficult habit to break once they are better.

If they feel hot or have a temperature, keep the room cool and if you need to, use an electric fan, positioned at the foot of the cot rather than directly on their face.

If they wake up in the night, don’t leave them to self-settle if they’re crying. They will not sleep if left in discomfort.

Even if they were fine when they went to bed, if they wake in the night, and suspect that they are unwell, go to them, pick them up and offer a cuddle and a drink of water [not milk if you’ve already dropped the night feeds – even if they didn’t have it at bedtime.] 

These actions alone can help to unblock the nose and the small tubes connecting the back of the nose to the ears, helping your baby to feel more comfortable. 

If they continue crying, and/or if they feel hot, you can give a [second] dose of infant painkiller, provided that it is a different family of painkiller than that which they had at bedtime. Or if it is the same one as at bedtime, you carefully follow the instructions supplied, concerning the timing and spacing of doses.

You can then remain close by and hold them if necessary, until they are calm and settled. 

Tempting as it might be, it is best if you avoid bringing them into bed with you if they are poorly, especially if they have a high temperature. It is safer for them to stay in their own cot, with you close beside them.

If your baby has a temperature above 38C, seems very unwell, has a rash or has a different cry, you should seek prompt medical help.

Copyright Andrea Grace 2024

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How to safely drop your older baby’s night feeds and help them sleep better

Guide to Drop Feeds During Baby's Nap Time

Most babies can sleep pretty much through the night by 6 months, but one of the main reasons why they don’t is because they develop a milk/sleep association. This happens if they are fed to sleep at the start of the night and/or are used to the ritual of a feed when they wake up during the night. 

Feeding and sleeping are very closely connected for babies – especially in the early weeks, and you can feed them to sleep without having them develop feeding as a sleep association until they are around 3 months. 

When your baby was younger, if they had a full tummy, it meant that they would sleep for longer and so feeding them to sleep is the right and natural thing to do.

When they are older, having a tummy that is very full of milk is less important. They need to be generally well nourished & hydrated during the day and not hungry when they go to sleep of course. But the main things that determine the quality of their sleep now are:

  • The way that they fall asleep
  • Whether they are expecting any nighttime events to happen.

It’s okay to feed your baby during the night for as long as you want to, especially when you are breastfeeding, and you should never feel under pressure to stop if it is something that both you and your baby enjoy. When you’re ready to stop, however, I have some tips on how to safely do it.

  • Wait until they are around 7kg. At this weight, it is okay for their bodies to rest for up to 12 hours at night.
  • If you haven’t already done it, introduce a familiar series of steps leading up to bedtime [a bedtime routine] timed to coincide with when you know your baby is tired and ready to sleep. 
  • Keep the bedroom light on for that bedtime feed, and don’t let your baby doze off. You may have to limit the duration if you’re breastfeeding or reduce the feed if they are on the bottle. Don’t worry – your older baby’s quality of sleep no longer depends upon how full their tummy is. 
  • Introduce a little picture book or song after the feed and before your babygoesinto the cot.This will further help to break the milk/sleep connection responsible for babies waking later and needing another feed to settle. 
  • Turn the light off now and place your baby into the cot whilst they are clearly awake. 
  • Depending on their temperament and your parenting style, either stay with them, comforting them in the cot or pop in and out frequently but briefly to reassure them. 
  • Be patient and give them time. If your baby has been used to feeding to sleep, they may struggle at first with self-settling. There is no rush – it might take an hour or so but if you let them, they will eventually fall asleep without you feeding them. Try to remain calm and reassuring if your baby is upset. Remember that they are getting used to a change and although it won’t be easy for the first night or two, it will be worth it in the long run.
  • If your baby wakes in the night, you should go and check them but not give a feed. Comfort them in the cot as you did earlier if they are upset. Provided that they are well hydrated in the daytime and are not unwell, they shouldn’t need a drink, but it’s fine to offer some water if you feel they need it.
  • Although it is fine to drop the night feeds all at once in healthy babies over the age of six months; if you’re nervous about doing this, it is OK to gradually dilute night formula feeds and/or to cut the duration of night breastfeeds. You need, for the sake of consistency to feed your baby a decreasing amount of milk at each waking. Feeding at some wakings and not at others will only confuse them.
  • Try not to confuse them by withholding or restricting night feeds and then giving a big, sleepy feed at dawn. They can’t tell the time yet, and as far as they are concerned, this is a night feed.

Just to say, that this is a guide. Each baby is different of course, and if you’re unsure, you should discuss your baby’s need for night feeds with your health visitor, doctor or other health care provider.

In one of the boxes above, I’ve said that feeding a baby sometimes when they wake and sometimes not can cause confusion. This isn’t the case when they are younger but as they grow up and their thinking develops, they can struggle to figure out why sometimes they get the feed response to their waking and other times they don’t. With this in mind, it’s best to drop them all at once if you can or feed them every time they ask for it but give smaller amounts.

Here’s a guide if you want to feed them at each waking but gradually reduce the amount before stopping: 

I know that the issue of night feeding, especially night breastfeeding is a sensitive one for many people and there are strong feelings involved. I would always encourage parents to follow their instincts and values.

Also, if you’re breastfeeding, don’t think that if you do decide to drop the night breastfeeds, you have to stop breastfeeding altogether. By 6 months your milk supply is well enough established for your body to make milk mainly for the daytime, when it is most needed!

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Bedwetting – All you need to know!

20% of 5-year-olds, 10% of 7-year-olds and 1 in 75 teenagers still regularly wet their bed.

Girls tend to be dry at night sooner than boys, but this isn’t always the case.

3 important things to remember:

  1. Your child doesn’t wet the bed on purpose. They are not being naughty or lazy.
  2. The fact that your child is late achieving nighttime dryness is not your fault! Some parents think they’ve left it too late/introduced too many changes in their child’s life/ been too relaxed etc. None of these things have caused your child to wet their bed.
  3. Having dry beds is a developmental milestone that like all the others, children reach at different times.

The biology bit:

During sleep, just as during the day, the brain receives a signal that the bladder is full. For many children, it’s not until they are a bit older that their nighttime brain receives this signal.

Our bodies naturally produce a special hormone called vasopressin. This hormone reduces urine production at night. If your child is still producing a lot of wee during the night especially if it is very dilute, then it’s highly likely that, their vasopressin production hasn’t yet kicked in.

Some children have “sensitive” bladders and their nighttime bed wetting is often part of a bigger picture of daytime wetness & accidents too.

Constipation causes bladder problems, due to the enlarged bowel pressing on the bladder and reducing its size and ability to expand.

How to help:

Give your child all they need for a healthy bladder and bowel!

  1. Encourage them to drink enough during the day [6-8 glasses.] The bladder needs the exercise of filling up and emptying out!
  2. Avoid fizzy or caffeine-rich drinks which can irritate the bladder. If they don’t like water, give them sugar-free squash.
  3. If they are at school, about half of their liquid intake will happen there, so it is really important that they refill their water flask. Ask your child’s teacher or TA to keep an eye on this.
  4. For good bowel health, give them a diet rich in fibre, plenty to drink and plenty of exercise.
  5. Restricting daytime fluids can cause the bladder to be less efficient so don’t go down this route!
  6. If you are still giving a bedtime bottle, you need to drop it.
  7. An hour before bedtime, discourage them from having a drink
  8. Use the toilet just before bedtime.

Explain to your child that you’re going to help them see if they can manage to have a dry bed, but try not to make them feel bad about it. If they are at school, they might already be feeling embarrassed about wetting their bed and they might also feel like they are letting you down. So keep the conversation positive and encouraging.

Have a calming and familiar bedtime routine.

Use waterproof bed protection and have spare bedding to hand in case of accidents.

Leave a soft light on and if the toilet is not easily accessible or if they are scared at night, have a potty in their room.

Many parents choose to lift their children and put them on the toilet later in the evening when they are 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, remain calm and if they wake up, change the sheets, encourage them to go to the toilet to see if they have any more wee left and then 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 night-time dryness or wetness for that matter 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, such as waiting until morning to have a drink or for going to the toilet when you ask them to, and so on.

Expect just the occasional dry night at the first few attempts without a nappy.

If they don’t manage a dry bed after 3 – 4 weeks of trying, you should give up and try again a few weeks later or when they start to have dry-ish nappies in the morning.

If they are still regularly wetting their bed after the age of 5, talk to your GP or school about getting a referral to a bedwetting clinic. These clinics will only see children over the age of 5.

The bedwetting clinics offer both assessment and treatment, often with a bedwetting alarm or medication. They also offer advice about sleepovers, school trips etc.

The important message here is that even if bedwetting goes on for a long time, children do achieve dry beds in the end and until that happens, neither they nor you should feel embarrassed or ashamed.

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Baby Sleep – Teething

How to help your baby or child sleep well when they are teething

It so often happens that just when a baby starts to sleep through the night, you hit the dreaded “teething troubles” or your baby gets poorly with a bug. You might need to give a bit more TLC during the night at these times, but that doesn’t mean that any progress your baby has made with their sleeping, has to go out of the window.

For most babies, this period of extra need is temporary, and 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 simply not sleep if left in discomfort, and leaving them to cry is not only unkind but also unsafe and could lead to them developing an unhappy association with the cot.

The most common baby ailment is teething, and although this is a natural process and not an illness, teething 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. 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. 

Fortunately, there are measures which you can take during the day, which will help your baby with nighttime teething.

  • Give them lots of opportunities to bite and chew. If they are old enough, encourage them with finger foods, such as crusty bread, bagel and toast which has been allowed to cool and go soft but tough. 
  • Because the 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 you should 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, where food and moisture can easily become trapped, and use a gentle barrier cream here to protect them even further.
  • If you notice that your baby is pulling at their ears, this is often a sign of discomfort and can indicate inflammation within the ear. This is common during teething, but to be safe, you will need to visit your GP who will establish the cause of the pain and then recommend a suitable painkiller. If the pain is caused by bacterial infection and not just teething, she or he might prescribe an antibiotic.

If your baby is unwell at bedtime and is old enough to have medication, you should follow your normal bedtime routine as closely as possible, being aware that your baby may be irritated at being handled. Before bath time give a dose of infant Paracetamol or Ibuprofen to ensure that they are pain-free and have no raised body temperature as they go to sleep. 

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. 

If you are intending to give your baby medication of any kind, you should always discuss it beforehand 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!

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.]

These actions alone can help to unblock the nose and the tiny tubes connecting the back of the nose to the ears and help your baby to feel more comfortable. 

If they carry on crying, and/or feel hot, you should offer a dose of an infant painkiller. You can then comfort them until they are calm and settled. You should try to avoid bringing your baby into bed with you if they are poorly and especially if they have a high temperature. 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; being given a night feed again or being rocked to sleep, for instance, for this behaviour to become a habit.

It will do no harm to relax the usual rules around bedtime and during the night when babies are unwell, then as soon as they are better you need to allow them to self-settle again at the start of the night, drop the night cuddles and let them get back to sleeping as they did before the illness.

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

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, but common symptoms are:

  • 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.

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 fibre in the form of fruit & vegetables.

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:

  • For the first 3 or 4 months, try not to worry about holding your baby too much or getting into bad habits if they can only sleep on you. 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.
  • Start their bedtime routine early enough so that you have the time to hold them upright for 20 minutes or so without them falling asleep on you.
  • Give their milk about half an hour before bath time and then by the time they go to bed, the milk should no longer be sitting heavily in their stomach.
  • 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.
  • Elevate the top of the cot, so that it slopes down at the foot, and place younger babies with their feet to the foot of the cot.
  • Give any prescribed medication in good time for it to work before bedtime.
  • 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.
  • Follow the principles of good sleeping generally, with a familiar and well-timed routine, and 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.

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.

There is more information about reflux and all things sleep related in my gentle sleep course.

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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 needing the cot for a new baby; but more often than not, it is simply the feeling that they are growing up and ready to move on a stage. 

Most children move out of the cot and into a bed somewhere between the ages of two and three and a half, but if they are happy in the cot and it is big enough for them, there is no rush or reason to move them at all.

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

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. 

During the day time before they actually sleep in the new bed themselves, encourage a game where they tuck their toys into the new bed and then leave them to go to sleep. Praise the toys for going to sleep. Through this small ritual they will receive the subtle message that you will be happy if they do the same. 

If they usually wear a sleep bag, now could be a good time to replace it with a little duvet, or sheet and blanket. 

Similarly, if they still have their milk from a bottle of milk at bedtime, now is a good opportunity to give them a cup instead. If you’re giving them a lidded cup, it’s best to make sure that it has a free-flowing design rather than being spillproof. This is so that they learn to sip rather than suck.

They can also now have a small flat pillow if you like, although from a physiological point of view they don’t really need one. 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 can be good opportunity to introduce those changes. The reason for this is that often a change in environment can help with a behaviour change or a change in routine.

It is best to avoid keeping the old cot in their room if you can, as this can often cause confusion and night-time bed swapping. Keep everything as simple as possible and avoid giving too many choices at night-time, and this will cut down on bedtime procrastination, tears and delay.

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 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 won’t go back to bed, you can remain standing quietly in the room with them. Tell them just once to go to bed and then wait in silence until they move towards the bed [it might take a while!] 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 to encourage them and let them know that you are proud of them. 

Don’t nag, bribe or get involved in any procrastination or delaying conversation. 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.” 

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, so that you can reinforce the message that even though their bed has changed, the “sleep rules” are the same.

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 uneasy and wakeful at first. 

If your child really does struggle to stay in bed, and you are worried about them wondering about at night, you could consider fitting a safety gate to their bedroom door. If you introduce it in a positive manner, “This is your gate, to keep you safe!” there is no reason for them to feel imprisoned.

You will also need to have some kind of soft lighting 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, you should help them back into bed as you did at the beginning of the night. Go to them every few minutes if they are upset and keep getting up, but try not to be in the room as they settle off to sleep, as this is very likely to then become a habit.

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!”

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Sleep advice for babies, toddlers and preschooler who wake up too early in the morning

Avoiding dawn rituals

If your baby or child is expecting to come into your bed, have a bottle, have you come and lay next to their cot etc. at dawn, they are likely to be wakeful earlier in the night, expecting this ritual to happen. Once they are old enough to go through the night without a feed, and provided that they’re ok and have just woken naturally with their sleep cycle, it is good to keep them in their own bed until morning and give them a reassuring but minimal response when they wake either during the night or at dawn.

Responding when they wake up early

When your baby or child wakes very early, it is fine to leave them alone if they are not upset. They may just be taking a bit longer than earlier in the night, to transition to their next sleep cycle. As dawn approaches, falling back to sleep can sometimes take an hour or more, and as long as they are not seriously crying, and you’re confident that they are safe and well, you can give them as long as they need. There is no need to intervene if they are merely awake and not upset.

If your baby is actually crying, it’s not good to leave them for a long time before going to them. It’s possible that they won’t manage to go back to sleep, and this is not a good start to the day for either them or you. It is far better to go to them before they become actually 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. 

Managing their naps

When it comes to their naps after a very early start, you need to avoid a very early or long morning nap, as getting into a pattern like this can “secure” or enable the early waking to continue

By all means, give them an early cat nap if they are struggling to stay awake, but keep in your mind that when babies are more than a few months old, good napping in the middle part of the day or early afternoon encourages better nighttime and early morning sleep.

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 so that you’ve got the energy to deal with it and also to protect your own mental and physical health.

For babies and little children, the deepest sleep of the night is before midnight. After this time, they sleep in recurring cycles of light sleep – deep sleep – light sleep – wake up. Each cycle lasts about 90 minutes.

As the night progresses, there is much more light sleep within the cycles, and the sleep cycles themselves become more fragile. There is little, if any deep sleep after about 4 am. 

This sleep “architecture” is normal for all of us, but it can be more problematic for little ones who are excited to get up and start the day, and who don’t understand that it is still too early!

The good news is that there are some very helpful things that you can do to help them sleep in for longer. These are:

  • Make sure that they are generally well-rested and not over-tired at bedtime.
  • Give them the skills to put themselves to sleep at bedtime and join their nighttime sleep cycles.
  • Give them clear time clues for daytime and nighttime.
  • Keep their sleep space dark and cool.
  • Avoid setting up any dawn rituals such as coming into your bed or giving unneeded feeds.
  • Respond in the most helpful way when they wake up too soon.
  • Manage their naps so that you are not accidentally enabling the early waking to happen.

Avoiding overtiredness

The reason why this can help is 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!

Building up their 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 – by helping them fall asleep as independently as possible at bedtime, when they’re full of sleep hormones and they have a lovely build-up of sleep pressure.

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.

Giving time clues

It’s important to be aware that little ones have no sense of how long they’ve been asleep for 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, then in the morning, you should open the curtains, and if it’s still dark outside, put the light on as well 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 incorporate closing the curtains before they go into the cot as a 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.

For the over 2s, a sleep training clock can be really helpful at demonstrating time cues, provided that you follow these 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, and 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 mustobey the clock if you expect your child to! It’s no good setting it for 7am 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! In so many cases, children run into their parents’ room at ridiculous o’clock, holding the device which is now on day mode, because they have altered the wake-up time.

Their sleep environment

Keep their sleep space as dark as possible, as this helps them to keep producing sleep hormones. If you need a night light, use one with a red or orange glow, 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 you] 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. 

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Night time potty training

Night-time dryness almost always follows daytime dryness and often there is a considerable period in between before your child will manage to achieve dry beds.

You should only ever 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.

It is not at all unusual for a four- or five-year-old to still be in night-time nappies and even then, many continue to have the odd accident throughout childhood. In fact, one in ten seven-year-olds still regularly wet their bed. Girls tend to be dry at night sooner than boys, but this isn’t always the case.

If your child has a very wet nappy in the morning and is no longer taking a night bottle or drinking a lot during the night, this is a sign that they are not yet producing enough of a special hormone called vasopressin. This hormone reduces urine production at night and until its action kicks in and if your child is under five, it means that they are probably not yet ready to come out of their nappy or pull up. 

It is perfectly ok to give them as long as they need, but if they are over five years old and you are worried, you might find it helpful to have a chat with your GP practice, school nurse or health visitor.

You can help your child to develop healthy bladder control by:

•   Offering plenty of fluids during the day. 

•   Stop them from having a drink an hour before bedtime

•   Drop feeds or big drinks during the night.

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

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 and encourage them to use the toilet before they go to sleep. Don’t make a big deal about it or over-pressurise them, however. 

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 your child wets their bed, it is best to remain calm and if they wake up, quickly change the sheets, encourage them to go to the toilet to see if they have any more wee left and then 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 night-time dryness or wetness for that matter 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, such as waiting until morning to have a drink or for going to the toilet when you ask them to, and so on.

 As with so many milestones, helping your child to become dry at night is more effective if you follow their lead. 

Here are some tips for night-time toilet training [once your child is dry during the day]

1. Encourage your child to drink enough during the day [6-8 glasses] – but not 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 your child 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, you should give up and try again a few weeks later or when they start to have dry-ish nappies in the morning. 

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The four-month sleep regression

Somewhere between about 3 and 5 months, babies settle into a mature pattern of sleep cycles – with light sleep, deep sleep and waking phases. 

They also are now producing their own supply of sleep hormones, such as melatonin. 

By now, they may also have the body weight to enable them to sleep for 5 hours or more stretches 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? 

Because also between 3 and 5 months, they become more conscious of what is going on and they start to make learning connections. 

These connections, especially if they are made as they fall asleep, can develop into expectations and preferences around their night sleeping and napping. 

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

Of course, it is fine to cuddle or feed your baby back to sleep if that’s what feels right for you or if that’s what they need, but bear in mind that if at this age, your baby starts 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, and this can be really disruptive to their sleep and to 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 little 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. 

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

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

There are a few things that you can do to help them along with this process:

1.    Feed on demand. Babies are more settled with a full tummy and lots of cuddles. Cluster feed” in the evening – late in the day, breast milk contains raised levels of Tryptophan – which converts to a sleep hormone.

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

3.    Wind them well after the final feed and introduce a familiar bedtime song or poem which will become a sleep cue.

4.    Try whenever possible to put them into the cot relaxed but still awake – or when they wake later, they may feel confused about no longer being in your arms. 

5.    When your baby starts doing longer stretches of sleep at night time, introduce a lovely consistent bedtime routine. 

The bedtime routine

The best bedtime routines provide a familiar series of steps leading up to them getting into their cot and going to sleep. Each of these steps will in time become a mini sleep trigger for your baby. The routine can be as short and sweet or as long as you like, providing that it works for you and is consistent. 

The best time tobegin your baby’s bedtime 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, or if they are naturally not falling asleep for the night until 10 or 11 pm, you’ll need to start the routine later at night.

Putting a baby to bed with lots of energy to spare is likely to result in crying and calling for you, and can result in them developing negative associations with bedtime.

Here’s the perfect routine! 

The majority of babies’ sleep problems are caused by babies being rocked or fed to sleep and then being placed into the cot once they are asleep. When baby wakes 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 waking in the night. What you can do is to teach them to feel safe and comfortable in the cot and how to settle back down. 

The best way to do this is to put them down awake at the start of the night, and then either leave them to self-settle if they’re ok with that or stay beside them using patting/stroking/kind words/singing etc. until they eventually settle. Give them as long as they need.

Remember that from about 2-3 months, they have a build-up of their own internal sleep hormones 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 for.  

These important factors mean that babies are biologically programmed to sleep at the end of the day. As long as you don’t break the sleep pressure by letting them get too drowsy in your arms before putting them down for the night, they will soon go to sleep. Just give them time and don’t lose your confidence.

There is more advice on this and also on how to help them when they wake up during the night in my Gentle Sleep Course.