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The Informed Parent

When Your Infant Won’t Sleep

by Louis P. Theriot, M.D., F.A.A.P.
Published on Aug. 19, 2013

The young father looked over at his wife and nodded. He quietly turned off the TV with the remote control, stood up, and carefully made his way to his wife who was sitting back in a recliner unable to move. Their four month old daughter had just fallen asleep. Dad clumsily leaned over to gingerly pick up his daughter, fearful he would awaken her. He furtively made his way to the nursery, holding her as if she was a time-bomb about to go off. Mom skirted ahead of him to prepare the crib. Night light on, blanket pulled back, everything was ready. As dad rounded the corner into the nursery he accidentally kicked the changing table creating a dull thud. He froze. He could feel his wife’s eyes piercing right through him. He didn’t need to see her face…he knew the look. He stood like a statue for seconds although it seemed like hours. Whew! She didn’t wake up. When his pulse returned to normal he gently leaned over the crib and put his daughter to bed. Mom covered her with a blanket, put the pacifier in her hand and they both snuck out quietly. In the hallway they “high-fived” each other and went on to enjoy the rest of their evening. They had it down to a real science…they should! This was the routine every night.

It is not uncommon for young infants to wake up once or twice a night. Quite often they fuss, whimper or move around but are not actually awake. They are just passing through a light phase of sleep. If left alone they should be able to fall right back to sleep. It is helpful for parents to try to put their infants to bed while awake. That way if the babies do wake up they are not startled expecting to be in mom’s arms. Usually they will look around, “coo” or talk, reposition themselves and fall back to sleep. But if they are accustomed to falling asleep in mom or dad’s arms, they will expect to be there when they awaken. When that is not the case they hit the panic button and cry.

This is what was happening to the family described above. After finishing the 11 o’clock news they got in bed and fell right to sleep…only to be awakened at 12:52 a.m. by the shrill cry of their daughter. Dad reflexively got out of bed to tend to the baby. He knows that it is his turn. Mom handles the 4 a.m.. wake-up call. The problem here is that when the baby fusses she wakes up to find that she is not in mom’s embrace. She cries. Within a minute she is in dad’s arms being fed. This has become a conditioned, or learned, response that is reinforced every single night.

At the next well-check the parents were desperate to resolve this nighttime ritual. They pleaded that they were willing to do anything to get their little girl to sleep all night. As it turned out they were willing to try almost anything. When it was suggested that they put their daughter in her crib awake, they scoffed at the mere suggestion.” No-way…won’t work…waste of time,” they both said. Mom laughed, saying that the baby would cry bloody murder before she could even hit the door. Probably so, I agreed. But much of what babies do in this situation is a learned response that is promulgated by our actions.

The parents were instructed to continue with their nightly ritual of cuddling, rocking and singing to their baby, BUT put her in her crib awake. Have a night light on with familiar things by her crib such as a mobile, busy box or stuffed animals. If the baby is in a bassinet, be sure that it is not too confining. Babies outgrow the bassinets before long. After putting her in the crib, pat her bottom, talk to her in a soothing voice and leave.

If she cries (she will) they were told to give it 2-3 minutes before going back in her room. Do not pick her up or feed her. Just be reassuring and comforting. Rub her back, pat her bottom, talk to her in a soft soothing voice to try to relax her. Then just leave. If she cries again (and she will), give it 5-7 minutes before going back in the room and do the same. Then 10 minutes…15 minutes…20 minutes, etc. Increase the interval before going in the room.     

The message that the baby will get is that 1) she is not going to be picked up automatically upon crying. She will learn to calm herself down and sort out her emotions on her own. She will come to learn that 2) mom and dad are nearby. Going to her at increased intervals is reassuring to her. Infants do not intuitively comprehend that their parents are just down the hall. It is something they have to be taught. When you leave their field of vision, you may as well be in Tibet. When you return to them at increased intervals however, it is comforting and reaffirms that they are safe and secure. And lastly, she will come to accept that 3) she is not going to be fed every time she whimpers. Older infants are capable to making it through the night without eating. They can get proper calories and nutrition for adequate growth during their awake time. Even babies that eat heartily a couple of times a night will adjust to making up the difference during the day. Following their growth curve will support this.

Parents who have found this approach unsuccessful will be the first to tell you that they just couldn’t go through with it. They couldn’t bear to hear their baby cry, or one of the parents had to get up early for work. And the easier, softer way was to just get up with the baby…which they continued to do every night.

The couple described above had a difficult time with this plan. They lasted about 10 minutes before they would go in and pick up their daughter. They were fascinated to note that after 10 minutes the baby’s cry had turned to a “mad” cry. It sounded as if she was mad until they picked her up. Then she would stops immediately. I confirmed that this is exactly what was happening.

Once they realized this, they were willing to give it one more try. They started on the Friday night of a three day weekend. The first night was “the pits”. At one point their daughter cried for 45 minutes straight…mad as a hatter. Her voice was even a little hoarse the next morning. They decided to stick with it and were exhausted, but the baby seemed just fine. Saturday night they were braced for another “hellish night”. To their surprise it wasn’t bad at all.

Sunday night the baby did not cry once. They heard her move around and “talk” at around 4 a.m. It was sweet music to their ears. 

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