Healthy Sleep Habits, Happy Child
176
Is my child hungry at night?
February 12, 2024

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Healthy Sleep Habits, Happy Child

5th Edition: 
A Step-by-Step Program for a Good Night's Sleep

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Healthy Sleep Habits, Happy Child

5th Edition: 
Chapter 1 (only 16 pages!) outlines everything you need to know about your child's sleep.

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Introduction

A Healthy Child Needs a Healthy Brain, A Healthy Brain Needs Healthy Sleep

Blog Posts 15, based on the United States of America Department of the Army Field Manual: Holistic Healing and Fitness, describe what really matters for your child’s sleep. If sleep is an important enough topic for national defense than surely sleep should be considered a serious topic for parenting!

Blog 176Is my child hungry at night?

Is my child hungry in the middle of the night? Between 6 and 9 months of age, when your child awakens at night and quietly cries or fusses, sometimes a parent is unsure whether to go to their child at night to offer a feeding or whether to ignore the quiet sounds. Of course, if your child loudly cries or fusses at night, consider that your child might be hungry, wet, soiled, or in distress and needs prompt attention.
Here are some suggestions that might help you decide whether your child is truly hungry:

Pay attention to the suck-swallow pattern.
The hungry baby will initially suck-swallow, suck-swallow, suck-swallow and so on. Every suck is followed by a swallow. Later, there may be more swallows for every suck.,
The baby who is not hungry will initially suck-suck-suck-swallow, suck-suck-suck-swallow, and so on. Many sucks and few swallows. Sucking is soothing so your baby sucks but because your baby is not hungry or thirsty, there are fewer swallows.

Have the father offer a test bottle of expressed breast milk or formula once in the middle of the night. Pay attention to both the volume taken and the time required for a feed.
The hungry baby will quickly suck down 3-4 ounces or more.
The baby who is not hungry will slowly suck down only 1-3 ounces.

Implement a 3-day trial of graduated extinction or extinction.
The hungry baby will not decrease crying or fussing over the 3-day trial. Stop the trial.
The baby who is not hungry will cry and fuss much less by the second or third night. Continue with graduated extinction or extinction (Blog Post 25).

If you are exclusively breast feeding and suspect that you might have insufficient breast milk because you are expressing less and less and/or you are feeling more and more thirsty during the day, or for whatever other reason, please consult with a lactation consultant.

All of these suggestions will help if, and only if, the bedtime (based on drowsy signs) is not too late. Why? A late bedtime creates night wakings. Because sucking is soothing, a late bedtime can create the illusion that your child is hungry at night when he is really overtired from a late bedtime.

Comments

  1. This is a great post and applicable for right where I am with my baby girl right now. She is 8 months old, exclusively breastfed (no bottle as I don’t express milk). We started sleep training with extinction about a month ago. There have been some up and downs with her getting sick right after we started and a mini vacation, and also figuring out a very early bedtime.

    She currently goes down at 5pm or just a few minutes after. She wakes up around midnight and I feed her. Then she wakes up around 3-4am again and cries very hard. So I feed her again. She then goes back until 5:45am-6am. I am hoping soon that there will be only one night waking for feeding and that maybe in the next moth or so, none.

    Right now we seem to be dealing with some sort of regression…maybe caused inadvertently by some inconsistencies on our part (maybe i nurse her until she is too drowsy and almost asleep sometimes?? Basically she is back to crying long spells when I put her down. So for example last night at 5pm I put her down and she was still crying hard 40 minutes in. My husband then went in and patted her back for only a few minutes and she fell fast asleep and stayed until midnight. She hadn’t been crying at the 5pm bedtime like that and just the night before fussed for maybe 1 minute.
    This morning for her 9am nap she has now been crying 40 minutes again. She was almost asleep when I put her in her crib and seemed so tired. But she has been sitting up in her crib crying now.
    Do you think i may need to start her nap earlier and not watch the clock so closely?
    I don’t think we can go earlier with the bedtime than 5??
    Should I just re-start the nap drill now and let her cry for an hour then get her up for both naps today? It feels so regressive because now she will be in a sleep deficit again if she doesn’t sleep for naps.

    While she didn’t have colic necessarily, she has been a more difficult temperament baby than I was used to. She protests very loudly and there were a few evenings when she was very little that she cried and cried no matter what I did. But I didn’t call it colic because it didn’t happen a lot. I am just wondering if she is going to protest like this every now and then based on her temperament?

    1. How certain are you that your breast-milk supply is ample? How long do you desire to exclusively breast feed? Please describe her usual daytime (nap) schedule.

  2. I guess I’m not 100% sure about my milk supply. I have never had the “normal” physical signs with the feeling of milk coming in or anything like that. But she had only breast milk up until 6 months and I just always went by her weight and wet diapers and she has always weighed in around the 80th percentile.
    Now that she eats food during the day, I usually can just tell she is getting milk because she stops drinking and will burp and things like that.
    I was planning to keep breastfeeding her until 12 months then see what happens.
    Maybe I can try and pump some just so we can see how much she is actually drinking at the night feed.

    Her daytime schedule has been:
    -9 am and 1pm nap or very close to those times. Originally when we started sleep training at 7 months the naps were very short…30-45 minutes. So there was no 3rd nap because I started doing the super early 5:30pm bedtime.
    -as we continued her naps lengthened and usually now she sleeps anywhere from 2-3 hours total during the day.
    -but now that she is back to crying when I put her down, today she didn’t get a 9am nap. She can barely hold her eyes open now at 12:10pm so I am about to put her down for a second nap try.

    1. “some inconsistencies on our part (maybe i nurse her until she is too drowsy and almost asleep sometimes??” Currently, what’s the usual ratio between ‘drowsy but awake’ versus nursing until asleep for naps, for bedtime, and middle of the night?
      What’s a common total duration of the actual breast-feeding? When she initially latches on, because she is hungry, she has a vigorous suck/swallow pattern (how long does this last?) and then she nurses with less vigor and more sucks to swallows (how long does this last) and then really slows down with many more sucks per swallow (how long does this last?).

    2. “She currently goes down at 5pm or just a few minutes after”: Please describe her behavior and mood between 3:30-4:30pm when alone with toys (no screens nor parental involvement).

  3. I need to keep better track of these types of nutritive vs non-nutritive/comfort nursing, because I honestly don’t know the answer. I will start keeping track.

    Overall she feeds about 15-20 minutes before bed and in the middle of the night. I do know she switches to non-nutritive at some point because she is still sucking when I pull her away, but she isn’t upset to be moved like when she is hungry and I move her.

    Maybe I can start to nurse her earlier in the bedtime process…she will usually seem asleep at the breast, but then I put her up on my shoulder and she wakes again but still seems very drowsy…like she rests on my shoulder and her eyes are slowly and heavily blinking. Then I lay her in the crib.
    Nursing is really the only soothing I have time to do because of how tired she already is. But it seems if I only follow cues I won’t get close to the wake windows and biological nap rhythm.

  4. She ended up only sleeping for about 50 minutes today for her second nap try, from 12:30 to 1:20.
    I will plan to start bedtime bath/nursing at 4:30pm, but I’m guessing she will be overtired by then.

  5. Between 3:30 and 4:30 she is usually eating or crawling around exploring. As long as she is occupied with something that interests her she seems engaged. But closer to 4:30 she starts becoming fussy and showing fatigue signs. She has always been a big ear puller (I’ve even taken her to the pediatrician to check her ears before realizing it was a fatigue sign.” I do feel like she goes very quickly from okay to signs of fatigue.

    It’s 3:40, she has been awake from her second nap (only nap she got today) for 2 hours and she is crawling around on her own exploring (with supervision of course, but not interfering).

  6. Update: By 4pm she was starting to get fussy and was doing some ear pulling and rubbing her face. Went outside with her to distract her until closer to 4:30.
    -Had a bath, then nursing by 4:50…heavy eyelids, blinking slowly but nursing consistently with suck/swallow rhythm. I left the light on hoping she wouldn’t fall asleep.
    She nursed for 10 minutes. Seemed satisfied, put her head down on my shoulder seemed very soothed and sleepy, then I put her into her crib awake at 5pm.
    -she started crying right away. Kind of a protesting, calling out type of cry. Cried for 20 minutes straight.

    1. Repeat:
      “some inconsistencies on our part (maybe i nurse her until she is too drowsy and almost asleep sometimes??” Currently, what’s the usual ratio between ‘drowsy but awake’ versus nursing until asleep for naps, for bedtime, and middle of the night?

      Please give some details regarding her self-soothing skills.

  7. Oh okay sorry didn’t understand. Well for a couple weeks she was going down awake 100% for naps and bed after the initial implementation of extinction. During the last week it’s probably 50/50.

    I’m wondering if I should nurse her at like 4pm, then do bath and then maybe let dad do soothing and put down, just so I really prevent her from falling asleep nursing.

    Do you think I should go to her around 3-4am if she has been up to feed around 12-1?
    Does it depend on how hard she is crying?

  8. Sorry left out…so she HAD been self-soothing pretty well I thought. In the middle of the night when I put her down she is awake and goes back with no fussing.
    She does a lot of head back and forth and she has a little dolly she likes to clutch onto and suck on a bit.
    But recently it seems like she is having a hard time self-soothing. She sits up a lot now that she has gotten good at doing that.

    I guess 20 minutes tonight wasn’t awful considering she missed her morning nap completely?

    1. At 8 months of age, waking up once at night for a feeding might not be a problem, but in the context of a sleeping issue, waking up around midnight and then again around 3-4am suggests sleep fragmentation. One possibility is that she is behaving this way because she is hungry. Meeting with your pediatrician and/or a lactation consultant should clarify whether the main problem is hunger and if so, how to solve it. Or trust your instincts that she is not truly hungry. Another possibility is that the main problem is habit feeding causing sleep fragmentation, and if so, extinction again should be considered (no feeding until once, if needed, early in the morning 3-5am with the expectation that she then afterwards falls asleep for a continuation of night sleep). Preventing her from falling deep asleep at nursing is appropriate and you know that I like the idea of getting Dads involved! Perhaps both issues could be present. In any case, because of your previous success with extinction, you know that she has great self-soothing skills, so please be optimistic. I hope this helps. Please let me know how it goes.

  9. Okay this all makes sense, thank you.
    Last night she woke at 11, ate for 20 minutes, went back easily.
    Then she woke again at 4:30, ate ver restlessly for 30 minutes and when I put her back in the crib she started crying. She stopped for a few minutes then started again and has been crying for 45 minutes. I will probably cap it at 60 which will at 6am anyway.
    Feeling like we are already starting the day behind at that point.
    I really wish I could drop the early morning feed because it seems to wake her too much.

  10. Hi Dr. Weissbluth. We have a 4.5 month old who’s sleep has been erratic and changing over the past few weeks. She has recently been fighting naps. She used to nap 4.5-5 hours a day and wake up many times throughout night. Now she naps about 3-4 hours a day and wakes up 3-4 times a night. We have been able to limit her to 2 feeds each night. We are trying to make a plan for extinction and are having trouble figuring out how to approach her feeds.

    Do you recommend timing night feeds and waking her to feed her at specific times (e.g., 10:30PM and 3AM)? Or should we wait until she wakes and cries? Currently her bedtime is 7PM. We initiate a feed at 10:30PM where she will usually take about 3-4 ounces. And then she will wake up again sometime between 1:30-4PM. When she wakes up at at 1:30AM we try to stall, but last night she was up for 1 hour and we ultimately fed her.

    1. Please describe her mood and behavior between 5pm and 7pm when alone (no parental interaction or screens).
      Do you put her down at 7pm drowsy but awake?

  11. Things have been erratic over the last 1-2 weeks as her day sleep has been changing and impacting her nights. She will usually take a 30 min nap sometime between 4:30-5:30PM and then wake up calm. We don’t leave her to play alone much and when we do, she will call out to us. For much of the time, she will want to be held and carried around until it’s time to start the bedtime routine. We do a 30 minute bedtime routine, change diaper, lullaby, massage, feed, bedtime story. She really enjoys this time and is smiley and attentive. Then we set her down, very sleepy with a pacifier. She used to cry for about 15 minutes, during which we would check in and replace the pacifier 1-2 times, and then she’d fall asleep. Over the last 3-4 days, she would cry longer when we first put her down for the night. We would try to rock her, but she would continue to cry for 30 minutes and we would ultimately feed her to sleep.

    Over the past 1-2 weeks, she has had a couple great nights (only waking up 1-2 times a night) and many horrible nights where she would wake up every hour. Over the past 4-5 nights we have been initiating a feed at 10:30PM in hopes of making sure she’s not hungry and trying not to reinforce her crying. She only takes 2-3 ounces and will not cry out to us again until 12:30-3:30AM. When she wakes up overnight, she used to settle quickly with a pacifier or after a feeding (if applicable), but more and more she is needing to be rocked to sleep and the past couple nights even wanted the bottle to sleep but won’t eat much more. After her second feed, sometimes wakes up every hour and needing to be rocked to sleep. We have been holding strong at limiting her to 2 feeds overnight.

    I’ve tried to summarize her general daily routine below:

    Before this, she used to only be able to stay awake for 1 hour before showing sleepy cues and needed to be put down for a nap but napped pretty well and could fall asleep in the crib drowsy but awake. Recently, she’s been tolerating staying up a little longer and so we’ve been pushing her to stay up longer to cut back on day sleep, in hopes she’ll sleep more at night. She has been harder to settle for naps and her naps have been shorter. She used to settle quickly with a pacifier, but over the last week or so, she’s needed to be rocked and required more contact naps.

    Typical day:
    7AM: wake
    8-8:15AM: start nap #1, 1-2 hours, used to go down very quickly with only pacifier and would sleep for 2 hours, but recently been taking a long time to fall asleep and ultimately needs to be rocked. Today, this was a full contact nap.
    11-11:30AM: start nap #2, 30 min to 1.5 hours, used to go down easily and sleep for 1.5 hours, but recently only naps for 30-45 min
    2:30-3:30PM: start nap #3, 30-45 min
    4:30-5:30PM: start nap #4, 20-30 min always fights this nap, full contact nap
    6:30PM: start bedtime routine
    7PM: bed

    We have been having trouble getting all her calories in during the day. She eats 2-5 ounces, 5 times a day. Her total daily consumption over the last two weeks has been consistent though, she has had an average of 25.8 ounces per day (we only bottle feed). Her first feed is usually the smallest – only 2-3 ounces, even if her last feed overnight was 5 hours before. Overnight we have been trying to limit her two feeds and 7 ounces total.

    Thanks for offering your assessment! We are trying to figure out how to have better sleep at night for her and are ready to try full extinction, but are trying to figure out when and how to feed her at night.

    1. Have you or your husband read the first few chapters in my book?
      “Recently, she’s been tolerating staying up a little longer and so we’ve been pushing her to stay up longer to cut back on day sleep, in hopes she’ll sleep more at night. She has been harder to settle for naps and her naps have been shorter. She used to settle quickly with a pacifier, but over the last week or so, she’s needed to be rocked and required more contact naps.” Suggests to me that your approach is the opposite of the advice I give in my book.
      Please clarify.

  12. A few weeks ago, when she was getting 4.5-5.5 hours of day sleep, there were a few nights I thought she may have been undertired. For example, after I fed her overnight, I layed her in bed and she would stay awake, smiling and playing for 20-30 minutes before falling asleep. Then she started waking up early from her first nap (short of 2 hours), so I thought I was supposed to stretch her first wakeful period. Based on my reading, I thought the ultimate goal was to get her first nap to be at 9AM and her second nap closer to 12-1PM. Perhaps we overshot and pushed her too quickly and now she is overtired again.

    We would like to put her down for earlier bedtimes. If she does an early bedtime should we wake her up to feed her the meal that she missed? I am still confused about how to approach nighttime feeds with the extinction method. Should we initiate feeds when we think she’ll be hungry or do we wait until she cries, make an educated guess as to whether or not she is hungry, and then feed her. Your book says she might wake 4-6 hours after her last feed and then again at around 4 or 5am, so it seems we should wait for her to wake and if it’s around these times, assume she is hungry? Otherwise, we let her cry?

    Appreciate your time demystifying this process. Thank you so much!

    1. Decouple feeding and sleeping in your mind. Drowsy signs for sleep are your clues for sleep onset. If she wakes at night and eats a lot, then you know that she was hungry. Do not wake her to feed her. Sleep comes from the brain, not the stomach.

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