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

(Content revised 02/2023)

After 6 months old, your baby still spends most time in sleep every day. It could be frustrating if your baby is difficult to settle or fall asleep at bedtime; If she wakes many times in the middle of the night, you would probably feel exhausted. In many aspects, sleep problems affect not only the child but also the family. If your baby has any of the above problems, you may explore the reasons behind…

Why do bedtime problems occur?

  1. Baby relies on parents' intervention to fall asleep

    Some babies rely on parental handling, like suckling, nursing, holding and rocking, gentle patting or walking to soothe him to sleep. Once these practices become a habit, not only does it affect his development of self-soothing ability, he also becomes overly dependent on your attention and company to sleep. When your baby wakes in the middle of the night, he often needs the same handling he gets when settle to sleep at bedtime. As he cannot fall asleep by himself, he may cry or signal to seek your help. This may make you spend much time and effort at the expense of your sleep as well.

    To handle this problem, you may let your baby develop his self-soothing ability early on  . You may refer to the methods described in ‘If your baby cries during the night'.

  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 babies can adapt gradually once a regular routine is re-established. Caregivers should communicate frequently and try to adhere to the baby's usual routines to ensure a smooth transition.

  3. Illness or discomfort

    Your child may stay awake and cry if she has physical discomfort or pain. You may need to seek medical advice if her crying persists.

  4. 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.

  5. Lack of routine in daily life

    Baby’s sleep pattern is related to his and the caregivers’ everyday routine. If both your baby and the caregivers have a stable daily routine, it is easier for him to establish a regular sleep pattern.

    While there are many ways to deal with sleep problems of the baby, often there is not an immediate way out. However, establishing a bedtime routine for your baby early on is fundamental. You may refer to 'The Lullaby 1—Developing Regular Sleep Patterns' for details. Discuss and handle consistently with your family members also helps.

If your baby cries during the night

If your baby wakes up and cries in the middle of the night, you may want to check whether there is a specific reason, e.g. his diaper is wet, feeling unwell, or he is hungry. When he sees you approaching, checking things out, and hearing your gentle voice, he may already be comforted and calmed down.

Most babies do not need a night feed by 3 to 6 months old. If your baby is not hungry, ill or in pain, he may cry during the night as he needs your help to fall back into sleep. Rushing in to respond to a baby’s crying by comforting or playing with him may make him stay awake longer. If your baby has already weaned the night feed, and you would like to help him learn to soothe himself, you may try to wait for a while before you respond to his cry. Given your preferences, circumstances and your baby’s characteristics, here are three approaches you can take:

  1. 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 comfort her without picking her up, such as gently patting or using a soft voice. Leave after a minute even if she is still crying. This approach reassures your baby that you will be available and attend to her needs. Wait for a longer time before you go and check on her crying again. The essence of this method is to progressively increase the period of time before checking on the child and spends only a short time settling him. You are not encouraged to stay and keep him company following this approach.
  2. You may stay with the baby in the room or even on his bed initially. As the child learns to independently fall asleep, you may move further away from the cot, until he could fall asleep without your presence in the room.

    If your baby's cot is placed near your bed due to limited space or you feel uneasy leaving your crying baby, you may stay nearby and pretend you have slept, and ignore his crying unless he is ill or in danger.

    Consistent and persistent management among your family members is required to make it work.

  3. For parents who want to help your baby learn to fall asleep by herself more quickly, after making sure she is not feeling unwell or in need of a diaper change, you may choose not to check her out or respond to her protests at all. When following this approach, caregivers should be prepared for an initial increase in intensity and duration of crying. Such behaviour is regarded as normal when using this approach and will eventually fade out when caregivers consistently and persistently applying this strategy.

The above approaches are supported by research evidence to be effective in managing bedtime problems and night wakings of your baby without causing any harm to her or your parent-child relationship. They help your baby to develop better sleeping habits and self-soothing ability, and support the wellbeing of both of you.

Different experts will have different suggestions and there is no single best way. You may choose the strategy with which you feel most comfortable and best suits the temperament of your baby. Whichever approach you use, be consistent and follow through so to make it work, or else you will 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.

Does my baby need to feed during the night?

Newborns‘ digestive system and appetite are yet to be developed. Frequent but small feed may suit them. As their day-night rhythm is developing, they may feel hungry in the middle of the night and need feeding.

After babies have developed day-night rhythm, they gradually eat more in the day time for nutrients but less in the night time. At 3-6 months of age, most babies get enough feed during the day and do not need night feeding. If your baby’s feed is short before he falls back to sleep in the middle of the night, he is not likely to be hungry, but he needs your soothing to get back to sleep. If you think your baby’s night feeding is a problem, you may try the following strategies to help him wean off night feeding*:

For breastfeeding babies:

  • Stop night feeding altogether if your baby suckles for less than 5 minutes. Use other soothing techniques to settle him
  • If he suckles more than 5 minutes, you may cut down the feeding time gradually in the coming 5-7 days
  • Cut down the feeding time by 2-5 minutes every two nights
  • Comfort and settle him after each shortened feed
  • When your baby feeds less than 5 minutes, cut night feeding altogether

For bottle-fed babies:

  • Stop night feeding altogether if your baby feeds less than 60ml. Use other soothing techniques to settle her
  • If she feeds more than 60ml, you may cut down the amount of feed gradually in the coming 5-7 days
  • Cut down the amount by 20-30ml every two nights
  • Comfort and settle her after each smaller feed
  • When your baby feeds less than 60ml, cut night feeding altogether

*Reference: Centre for Community Child Health, Royal Children's Hospital (2012-2016). The infant sleep elearning program. Melbourne: RCH.