Ask the Doctor - Answers to your Parenting Questions

Dear Emily,
There is, unfortunately, no easy solution to getting babies to sleep at night, because the nature of babies is to wake up and nurse. In fact, everything I have read convinces me that babies under a year old need nourishment at night.  Nursing moms are not designed to tackle a busy schedule the next day, so our modern culture clashes with the needs of babies.

But there are ways to get more sleep while your baby is under a year old, and to night-wean him once he reaches a year.

So what can I tell you that might help?

1. If your son’s night-waking includes fussiness, he should see a doctor. If he is easily comforted and goes right back to sleep, though, he is normal.

2. Babies in most of the world sleep with their parents. Those babies are not considered to have sleep issues the way babies in the US do. They do wake up to nurse, at least for the first year and often into the second year. The moms try to not really wake up, they pop in the breast and go back to sleep. For the second breast, they just roll over a bit, rather than moving the baby.

3. Many babies whose mothers work during the day often wake a few times at night to nurse, and it seems they are partly looking to connect with their mothers. But it is developmentally normal for all babies to wake at night to nurse. Studies have shown that ALL babies wake up during the night and 50% of 12 month olds require parental intervention to help them go back to sleep.

4. My unscientific observation is that babies who sleep in bed with their parents and nurse at night wake more often for longer.  Sometime after twelve months, many of those moms night-wean so so the baby stops waking up to nurse.  However, I also hear from those moms that it is not only a delight to have their babies with them, but co-sleeping helps moms get more rest in the early months, when all babies wake often. And all babies begin to sleep through the night sooner or later, at their own developmental pace, even if the parents do nothing to encourage it.

5.  A baby under a year old may well need to nurse a couple of times at night. It may be hard to wait until your son is old enough to night-wean, but babies under a year old do need to eat at night.  Breastmilk doesn’t keep them for long, and especially during growth spurts they may be hungry at night. Babies all over the world nurse at night into the second year. Since you are already giving him solids, try giving him healthy snacks (sweet potatoes, yogurt) all day so he tanks up. And of course, make sure he really nurses during the day. Often babies get very busy and alert and distracted and don’t nurse enough during the day.

6. It is time to ask yourself if you really need to try to force your son to sleep by himself.  Your son is clearly not a kid who can be easily sleep trained. You have tried everything and he has fought it.  Maybe he should just sleep with you and you should just not worry about it. Your goal has to be maximizing your own sleep. There is nothing wrong with having your son sleep with you and nurse for now, if that gets you more sleep. Many moms find that it does.

7. For now, you may want to simply go to sleep early so you get nine or ten hours of (interrupted) sleep, and try to sleep through nursing as much as possible. Try blackout shades in the bedroom to buy yourself an extra hour of sleep in the morning. Also, if you offer your breast just before you go to sleep, your son will almost certainly take it and suck without really waking up. That “fill-up” may buy you a longer stretch of sleep if you then go to bed right away.

8. Give your son another way to fall back asleep. Some little ones who wake often are not actually hungry; they just use nursing to get back to sleep.  The issue with nursing to sleep, as you know, is that he gets used to it and has a hard time falling asleep without it. I assume you have already tried a pacifier and he won’t take it, but if you haven't you may want to try one.

9. Form other sleep associations.  Research from Miami University showed that infants and toddlers who were massaged daily for one month, for 15 minutes prior to bedtime, fell asleep more easily by the end of the study. If you try this, even massaging while he is nursing, you may find that eventually massage will induce the same comforting feelings as nursing and put him back to sleep.  You can also try singing a certain song to him.

10.  Get him used to doing without night snacks.  Since he is almost a year old, he can probably learn not to be hungry in the middle of the night and to eat more during the day.  If he takes a bottle of breastmilk, and you can give him the bottle at night, that can be a good transition in which he gradually gets used to not nursing at night.  Once he is used to the bottle instead of nursing at night, you can begin gradually diluting the milk until it is so watery it isn’t worth waking up for, and if he does, and he is sleeping with you, who cares? Hand him the bottle and let him suck himself to sleep on the water. It won’t hurt his teeth and after awhile he will fall asleep in two sucks or not wake up at all. But I am assuming that your son doesn’t take a bottle, from your description.

11.  Consider night-weaning.  If none of this works for you, and you are indeed "desperate" for some sleep, then once your son is over a year old, you can consider night-weaning your son so he learns to fall asleep without nursing.  I believe that you being rested and patient during the day is more important than nursing him at night once he is old enough. You will probably have to wake to nurse him at dawn, and it may be a marathon session, but you can night-wean him. 

12. Break the nursing/sleep association.  When humans sleep, they go through sleep cycles that include dreaming, deep sleep, and light sleep.  Babies need to wake up to eat as they transition into light sleep.  Once they nurse, they fall asleep again.  Right now, the only way Ben can put himself back to sleep at night is nursing, because it is the only way he ever falls asleep. But like all humans, he can learn to roll over and go right back into a deeper sleep, without ever really awakening.  

I have seen this method work miracles. I should warn you that this is a cold-turkey approach, since he is used to eating at night and is likely to be hungry in the night while he adjusts to getting all his calories in the daytime.  But it is not Ferberizing because you stay with him.  It will not traumatize him, because you hold him and honor his upset about not being able to nurse. Almost certainly, once Ben learns to fall asleep without nursing, he will not need your help in the middle of the night to go back to sleep. 

13. How to night-wean.  Start by explaining to your son that his “milkies” or whatever he calls them, go to sleep at night, and there is no milk until it is light out. (Some moms put band aids on their nipples so their child can see that they're "broken.") Then, you tell him “Baby go night night, mommy go night night, milkies go night night.”    He is young, and won't completely understand, but he understands more than you think.   You might even act out a scenario with his teddy bears, where the baby bear asks for milk at night and is told "no milkies at night."

When he wakes in the night and wants to nurse, you can rock him or walk him, but stick to your guns, tell him the milkies are sleeping, and don’t nurse him until it's light. He will cry, and you will have to accept his grief and rage about losing his night nursing, and this could go on for a few nights or more, especially if he is not old enough to really understand, but it will work. 

14. Enroll Dad's help.  If it is too hard for you to deny your son, enroll Dad.  You'll need  to nurse him in another room so he doesn't fall asleep, and then vanish at bedtime for awhile. Your husband will need to walk him, rock him, hold him while he cries.  This crying will be hard for everyone, but crying in your husband’s sympathetic arms is not the same as "crying it out." We don't have to give our kids everything they ask for, but they do need our empathy and comfort when they react with upset to the situation.

Eventually, your son will fall asleep.  He is likely to wake up looking for you in a few hours, and Dad will have to be "on duty" again at that point.  But he will eventually settle down to sleep again if your husband rocks or walks him.

It’s best to wait until Dad has a vacation from work, or at least start on a Friday night.  He gets your son to sleep, probably somewhat past his normal bedtime. The baby wakes up a few hours later, and Dad comforts him, walks him, gives him a drink from a sippy cup, rocks him, etc. The first time he wakes, of course, he may go ballistic at your absence. Your husband may want to give up at this point, so make sure when you discuss it with him in advance that you point out that the first waking (when he's rested and mad) is the worst. Usually it is best if the baby is actually in your bed with Dad, because then Dad can intervene faster so the baby doesn’t fully wake up after the first time. If he doesn’t sense your presence, he has no reason to wake. Make sure you sleep far away, and use earplugs if necessary, and have faith that your husband and son will work this out.

After two or three nights of this, your son will be able to fall asleep without nursing, and will have started on a new kind of  sleep association.  You don't want him to stay long in the pattern of being rocked to sleep, or he will need to be rocked when he wakes in the middle of the night.  So start introducing other sleep associations that will be there in the night, for instance white noise. Research shows that babies like white noise, and that it can put them back to sleep when they partially wake at night. 

Also, your husband should hold the baby in the position he will put him down in (on his back) while he rocks him to sleep.  It is best if he can rock, then be still, then rock, then be still, which gradually gets Ben used to falling asleep on his back without moving.  Eventually, he will be able to be put down drowsy in his bed and will fall asleep, as unbelievable as that now seems.

15. Consider waiting to night wean. Finally, I want to reassure you that as your son gets more verbal it will be easier to wean him at night.  You should always explain what you're doing to your child, and it helps no matter how little they are, but the older they are, the more they understand, and the easier this process is for everyone.  Also, a 15 month old is a a lot older than a 12 month old, and is less likely to need the night nourishment.

This process accomplishes your goal of helping your baby learn to fall asleep, and return to sleep, in a loving and respectful way that won't traumatize him.  Sweet dreams!

Dr. Laura