Q&A with a Certified Pediatric Sleep Consultant: Part III

Katie Pitts, Certified Pediatric Sleep Consultant from Sleep Wise Consulting helps families handle sleep situations with young children. See what questions Nourisher moms asked Katie in her third Q&A. Don't forget to read through questions from Part I and Part II.

Transitioning from a Crib to a Bed

Holt: What’s the best way to go about transitioning my 2.5 year old from a crib to a big boy bed? I know it’s time, but I’m terrified.

Katie: My first piece of advice is to wait :) I find parents have the most success with this transition when a toddler is 3 years old. Before then, many are not developmentally ready for this change. If he's happily still sleeping in his crib, hold off for another 6 months (or even longer!). Once you decide to move forward, preparation is crucial! Get him excited about this process by having him involved in the bed set up. Have him choose his bedding, possibly a new pillow, etc. Then, make sure you set boundaries. Have a consequence ready should he get out of bed. Reward charts can be a great idea if you ever need to get good habits back on track as well!

Holt: How long would you say is too long in a crib?

Katie: Around 3.5 - 4, if he's still in a crib, go ahead and make the switch!

Moving an Overly-Attached Infant into Their Crib

Maria: How can I get baby to sleep and stay in his bassinet or just anywhere that is not my arms/chest? My son is 2 months old and he will not nap or sleep at night if it’s not in my arms/chest. I’ve tried absolutely everything. The only way he stays asleep is on his tummy which I don’t do because it scares me so much. He’s really not on a strict routine yet because he is so young, but it goes a somewhat like this.

Katie: I agree with you about the tummy sleeping but also would love to see him in his bassinet ASAP as neither of you are getting quality sleep in your arms/chest and you must be exhausted! It looks like your morning is starting around 9:00 am which means you want his night to begin at 9:00 pm. Putting him in bed overtired will set you up for failure! After he wakes from his last nap, try to have him in bed within 45-60 minutes after a relaxing routine (i.e. bath, song, feed, bed). If he cries, pick him up to calm him. Once calm, try putting him down again. Repeat this process as many times as it takes!

Teaching a Child to Soothe Himself to Sleep

Kaitlin: Baby boy still wakes up frequently just to be comforted back to sleep with a bottle. Just turned 8 months. How do I wean him of this sleep prop?

Katie: You will want to start at bedtime with your routine. Make sure he is going to bed 3-4 hours after he wakes from his last nap. Do a simple routine of bottle, bath, books, and then into bed. Make sure he is not relying on the bottle at bedtime to fall asleep which will then transfer to middle of the night. If he is going down 100% wide awake at bedtime and you are still having this difficulty in the middle of the night, then, if you have the go ahead from your pediatrician, you will want to pull that bottle and respond to his cries with other types of comfort. The goal is that he ends up putting himself back to sleep!

Sleep Training Twins

Graziela: Can I really get my 6 month old twins to sleep through the night together? One has slept for 12 hours with 4 bottle feedings, eyes open, feed, eyes closed within minutes. His brother wakes up for a night feeding and stays awake for 2 hours, almost like his daytime nap schedule.... what do I do? They nap about 2-3 times a day.

Katie: Absolutely!! I've worked with several twins and the results are amazing. The key is to put them down 100% wide awake at bedtime and naps. If you do this, they will rely on their own sleep skills and wake only out of hunger, rather because they need your help going to sleep!

Teaching Healthy Sleep Habits to an Infant

Sheryl: At what age should we be more mindful of how our son falls asleep as it relates to how he stays asleep? Right now it takes a generous amount of rocking and holding him in order for him to fall asleep and then we transfer to the crib. Is this setting a pattern for needing a parent to be there when he falls asleep, or is he too young to be affected? He is 8 weeks old! 

Katie: I believe in starting to teach healthy sleep habits as early as possible for our little ones. This does not mean sleep training at this age, nor does it mean allowing crying. What I mean by this is that it's okay to work on putting your baby down awake once in awhile so he learns his own sleep skills. I would start with trying to put him down sleepy but awake at bedtime and then possibly first nap but for the rest of the naps, do whatever works! Once he is successful in this, try adding some other naps. This way, as he gets older, his sleep will continue to improve without you ever having to do any “sleep training”.

Helping a 5-Month Old Sleep for Longer Stretches

Katharine: For the past few weeks my 5 month old went from waking up once a night to being up multiple (4+) times through the night to feed. How can I get him to sleep for longer stretches? He sleeps from 8:30/9pm till midnight and then is up every 1-2 hours till 7:30am. We exclusively breastfeed, and he sleeps in a cosleeper next to our bed (ending up next to me in bed after the 3rd wake up). He naps a few times a day, but only if I'm holding him and nursing him, if I put him down he wakes up.

Katie: It sounds like your little guy is relying on a sleep prop. A sleep prop is anything external a baby uses to fall asleep and stay asleep. At this age, he might still need a middle of the night feed (it depends on his weight and calories during the day) but taking away sleep props will allow him to wake up only when hungry, not because he just does not know how to put himself back to sleep. I would recommend starting with a soothing bedtime routine of nursing, bath, pjs/massage, book and then into bed 100% wide awake. Start with bedtime and then continue with independent sleep for naps the next day. Have a plan for comfort if he is upset and stick with it 100%!

Comforting an Infant Who Wakes During the Night

Shibahn: What should I do when my baby cries at night and I know it’s not a diaper or feed need? As soon as I pick her up she will stop. She is only 5 weeks old, so we definitely don’t let her cry for more than 5 minutes. It’s not a nightly but when it happens it feels like a constant cycle. Her schedule is (exclusive breastfeeding):

6-7am feed
9- feed
12-feed
3-feed
6-feed 
8:30pm- bath and tender time
9- feed usually breast milk from bottle. 
12am feed
Middle of night feed when she wakes

We play after feed/diaper change except for after the early am and late night feeds. Sometimes we adjust the schedule by up to an hour based on the first morning feed. So if she wakes up at 8am instead of between 6-7 we just move it all up.

Katie: At this age, it's likely your baby still needs to nurse every 1-3 hours throughout the night. Hang in there for one more week! At 6 weeks, your baby's circadian rhythm will start to mature and she will begin figuring out nights/days and start to consolidate nighttime sleep (going 3-5 hours between feeds). To set yourself up for success, make sure she is not awake too long before bedtime. Once she wakes up from her last nap, have her down in bed 45 minutes later! This guide will also have some helpful tips for you: http://sleepwiseconsulting.com/free-download/ It sounds like you are off to a great start though!

Breaking a Habit of Nursing to Sleep

Erin: Our daughter is 4 months and we co-sleep and exclusively breastfeed. Although I don’t mind it and understand she’s young and just a baby and don’t expect her to go so long without eating, she often “snacks” throughout the night. I think it’s just for comfort, how can I “wean” her from this habit? It seems like she wakes to suck more than actually eat and she doesn’t really like any pacifiers we’ve tried.

Katie: I completely agree that she might still need some nursing sessions in the middle of the night but waking that often is likely due to her not having her own sleep skills. The key here is to get her nice and relaxed before bedtime but put her down while she is still awake. Then, when she wakes in the night, give her a few minutes before responding. She could surprise you and fall back asleep on her own! If she doesn't, go ahead and feed her but once again, keep her awake. The key is that she is learning to put herself to sleep in sleep situations rather than relying on only nursing to do this!

Understanding Night Terrors in a Child

Lauren: How early can night terrors start? My son (now six) has had night terrors since he was very little, maybe 1.5 years old. Now my 10-month-old daughter has been waking around 2 am every few nights screaming. For hours. Nothing we do helps. It’s been a while so I’m not sure, but it reminds me of my son’s very young night terrors. 

Katie: Night terrors typically start between the ages of 2-4. I have yet to see them happen this young but it is possible. What makes me think it is not a night terror is the length of the waking. Night terrors generally last between 5-15 minutes. When you go in the room, your baby would not recognize you are there. This seems to be either a sleep association difficulty (she needs something external to help her back to sleep) or a scheduling issue. She is getting a lot of sleep for her age so it's possible that could be what is impacting the waking. At this age, she needs 12-15 hours of sleep. I would try capping her second nap at 2:00 so she is at 3.5 hours of daytime sleep instead of 4. You don't want to extend wake time between last nap and bed anymore so try putting a little wake time before first and second nap! There are some other scheduling adjustments we could do if you don't find this is helpful.

Cutting Back on Daytime Sleep to Lengthen Sleep at Night

Erin: My 9 month old boy has been trying to switch from 3 to 2 naps but still takes 3 fairly often and they usually total 3-4 hours. He goes to bed between 7:30 and 8 at night but has been waking up for the day at 4 or 5! How do I get him to sleep later?

Katie: His early wakings are likely related to too much daytime sleep. I would slowly space out his awake times during the day to spread out the naps and cut down on daytime sleep. At this age, I like a schedule of:

7:00 Wake up
9:30 - 11:00 Nap
2:00 - 3:30 Nap
7:00 Bedtime

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