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

(Content revised 12/2019)(Reprinted 06/2020)

After 6 months old, your baby still spends most time in sleep every day. If baby resists or is difficult to fall asleep at bedtime, you may be distressed about it. If she wakes many times in the middle of the night, you would probably feel very tired. Sleep problem not only affect children but also the family in various aspects. If your baby has any of the above problem, you may explore the reasons behind…

Why do bedtime problems occur?

  1. Baby relies on parents' intervention to fall asleep

    If your baby relies on your handling to fall asleep like suckling, nursing to sleep, holding and rocking, gentle patting or walking to soothe him to sleep. Once these practices become habits, this not only affect his self-soothing ability, he also becomes totally dependent on you and your accompany to sleep. The way(s) your baby settle to sleep at bedtime has/ have to be repeated when he wakes in the middle of the night. 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 need to let your baby develop his self-soothing ability. 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 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. 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

    If your baby lacks daily routine, it is difficult for her to have routine on sleep. When the carers have daily routine themselves, the routine of the baby can be easily established.

    There is not a single way out for sleep problems of the baby. Establish bedtime routine for your baby as early as possible is the basis of all. You may refer to ‘The Lullaby 1—Developing Regular Sleep Patterns' for details. Discuss with your family members and work together consistently may help.

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. The essence of this method is the caregiver awaits progressively longer period of time before checking on the child and spends only a short time settling the baby and places him being drowsy but awake in bed alone.
  2. The caregiver stays with the child in the room or even on his bed initially. As the child learns to independently fall asleep, caregiver's presence is gradually removed from the child's room.

    If your baby's cot cannot be placed near your bed due to limited space or you are feeling unease leaving your crying baby, you may prefer this gentle approach. You may stay on his bed and pretend you have slept and ignored his crying unless he is ill or in danger.

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

  3. Make sure your baby is not feeling unwell or needy of changing diapers, do not respond to her protests at all or go to her room and check. This will not harm her but helps her learn quickly how to fall asleep by herself. You may use this approach if you think she cries only to get your attention.

    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 fade out when caregivers consistently and persistently applying the strategy.

The above approaches are supported by research evidence to be effective in managing bedtime problems and night wakings of young baby without causing any harm to her or impeding your relationship with her. They help your baby to have better sleeping habit and the wellbeing of both of you.

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.

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 eat more in the day time for nutrients but gradually less in the night time. After 3-6 months of age, most of the 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, your baby is not likely to be hungry but asks for your soothing to get him back to sleep. If you think your baby's night feeding is a problem, you may try the following strategies to help him/her 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
  • Then cut down the feeding time by 2-5 minutes every two nights
  • 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
  • Then cut down the amount by 20-30ml every two nights
  • 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.