Parenting Series 6 - The Lullaby II - My Child Won't Sleep

Babies spend more than half of their time sleeping everyday. When they refuse to sleep or cry at bedtime, many parents will feel very frustrated and even be at the end of their wits. It can be exhausting especially if this happens in the middle of the night.

Sleep problems affect not only the child but also the rest of the family. There is no instant magic in solving these problems. This leaflet provides information on some causes of sleep problems and suggestions on practical management.

Why Do Bedtime Problems Occur?

  1. Poor Sleep Habit
    One of the commonest bedtime problems is poor sleep habits. For instance, some babies need a dummy, or to be fed, rocked, stroked or walked until they fall asleep. Once these patterns have become routines, your baby will depend totally on your attention and company to sleep. This will take up much of your time and energy unnecessarily.

    To prevent your baby from developing poor sleep habits, the basic strategy is to help your baby establish a bedtime routine and fall asleep independently as early as possible. You may refer to the leaflet The Lullaby I - Developing Regular Sleep Patterns in this series for details. The following section on 'If Your Baby Cries during the Night...' also provides some strategies you may find useful.
  2. Disruption of Normal Routine
    Change of caregiver, hospitalization and other changes in daily activities may disrupt normal routine. The resulting bedtime problems are usually temporary and often correct themselves once regular routine is re-established. The caregiver should understand and try to adhere to the baby's usual routines to ensure a smooth transition.
  3. Over or Under Feeding Before Sleep
    Feeding too much may cause physical discomfort and hence difficulty to sleep. On the other hand, your baby may stay awake if she is hungry. As you become familiar with your baby's signals and needs, you will know how to adjust to her appetite.
  4. Illness or Discomfort
    She may stay awake and cry if she has physical discomfort or pain. You may need to seek medical advice if her crying persists.

If Your Baby Cries during the Night…

During the early months, if your baby cries after being put to bed or in the middle of the night, you may want to go and check whether there is a specific reason, e.g. his diaper is wet, or he is hungry. When checking things out, let him see your face and hear your gentle voice. By doing so, you might have comforted him and calmed him down.

Most babies do not need a night feed by 3 to 6 months old. If your baby has already weaned the night feed, and you know that he is not ill or in pain, responding to his crying during the night by comforting or playing with him can accidentally reward his crying and may make him stay awake longer. You may try to wait for a while before you respond to his cry. To help him learn to comfort himself instead of depending on you, here are three approaches you can take:

  1. This approach reassures your baby that you will be available and attend to her while discourages you to stay with her for more than a minute at a time. If your baby cries after being put to bed or during the night, do not respond straight away. She may quiet down and fall asleep again after a few minutes. If she is still crying after 5 minutes, you may return to console her without picking her up. Leave after a minute even if she is still crying. Wait for a longer time before you go and check on her crying again. Lengthening the time in between your checkups helps your baby learn to comfort herself.
  2. This approach can be used if you prefer a more gentle approach or if your baby sleeps in a cot in your room. When he is awake, you may lie down on another bed in the same room and pretend to be asleep until he falls back to sleep. Do not attend to his cries unless he is ill or in danger.
  3. When you have decided that your baby only cries to get your attention, you may use this approach. Do not respond to her protests at all and do not even go to check. This will not harm her but helps her learn quickly how to fall asleep by herself.

Different experts will have different suggestions and there is no single best way. You should choose the strategy with which you feel most comfortable and which best suits the temperament of your baby. Whichever approach you use, you need to be consistent and follow through. If your baby learns that screaming will bring you back to pick him up, he will not learn to fall asleep independently. You will then be caught in a vicious cycle of escalating sleep problem.

When managing sleep problems, taking care of yourself is very important. Success of your strategies depends very much on you and the cooperation and support of your family. If you have any concerns about your child's sleep, you may seek advice from the medical professionals.

We have a series of "Happy Parenting!" workshops and leaflets for expectant parents, parents of infants and preschool children. Please contact our healthcare personnel for information.

(Content revised 12/2010)