Healthy Sleep Habits, Happy Child
44
Post-Colic Sleep Problems
September 13, 2021

Found in age groups

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Introduction

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

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.

When children are not sleeping well, the cause might be the father, the mother, the baby or any combination. Even if the root cause or trigger might occur within the father, or the mother, or the baby, as time passes, interactive effects develop between all three. In order to help solve sleep problems, without judgement, it is important to consider all possible causes (Blog Posts 17 and 18).

Parents may have symptoms of anxiety or depression or habitual thoughts and beliefs that might, or might not, contribute to or cause sleep difficulties in their child. This topic is confusing because some studies look only at the father’s role and others look only at the mother’s role. Some research suggests that a colicky baby (Blog Post 20) might trigger these symptoms in the parents. Interactions between each parent and the baby are important. Therefore, it is difficult to make firm conclusions about the direction of effect. Blog Posts 3942 share studies that describe how parent’s issues might contribute to or cause sleep difficulties in their child.

Blog 44Post-Colic Sleep Problems

POST-COLIC SLEEP PROBLEMS

I studied 141 infants between 4- 8 months of age and showed that the history of colic was associated with the parents’ judgment that night waking was a current problem. Other studies also reported more night waking at 8-12 months and at age 14–18 months in post-colic children compared with babies who did not have colic. Also, among those post-colic infants, the total sleep duration was less (13.5 versus 14.3 hours). So post-colic infants tend to have, for several months, brief sleep durations and more frequent or longer night awakenings (signaling).

One possibility is that biological features within the child contribute to post-colic sleep problems after the fussiness and crying end. However, two separate and well-designed studies agree with Dr. Ian St. James-Roberts that “high amounts of early crying do not make it highly probable that an infant will have sleeping problems at nine months of age.” Since infant crying, alone, is not a prediction of later sleep problems, the possibility that persisting biologic factors causing post-colic sleep problems is unlikely.

Another possibility is, from the perspective of a parent-driven path, that most post-colic sleep problems are not caused primarily by a biological disturbance of sleep/wake regulation; rather, the problem is the parents’ failure to allow their baby to learn self-soothing between 2 and 4 months or to establish regular sleep patterns when the colic dissipates.

Two or more months of crying sometimes adversely and permanently shapes parenting styles. An inconsolable infant might trigger in some parents a perception that their baby’s behavior is out of their control. They observe no obvious benefit to their young colicky infant when they try to be regular according to clock times or to be consistent in bedtime routines. Naturally, but falsely, they then assume that this handling will not help their post-colic child, either. Unfortunately, they do not observe the transition, at around 2–4 months, from colicky crying to fatigue-driven (sleep-deprivation) crying.

Alternatively, some parents may unintentionally and permanently become inconsistent and irregular in their responses to their infant simply because of their own sleep-deprivation. The constant, complex, and prolonged efforts they had used to soothe or calm their colicky baby are continued. But these efforts ultimately lead to an overindulgent, oversolicitous approach to sleep scheduling when the colic has passed. Their nurturing at night, for example, becomes stimulating overattentiveness. In responding to their child’s every cry, the parents inadvertently deprive her of the opportunity to learn how to fall asleep unassisted. She then fails to learn the important skill of self-soothing, which she will need her entire life.

Some mothers, with anxiety, have difficulty separating from their child, especially at night, and their own developing sleep deprivation or insomnia might lead to depression. If a child fails to learn to fall asleep unassisted, the result is sleep fragmentation or sleep deprivation driven by intermittent positive parental reinforcement. This causes fatigue-driven fussiness long after the colic has resolved, which ultimately creates an overtired family. Fathers’ behavior may contribute to or cause anxiety or depression in the mother (Blog Post 39).

Support for this view comes from research on infants at 5 months of age who were followed to 56 months of age. Dr. Dieter Wolke, in agreement with Dr. Ian St. James-Roberts above, showed that infant crying alone was not the problem: “Sleep problems are likely to be due to a failure of the parents to establish and maintain regular sleep schedules. This conclusion does not blame parents for sleep difficulties. Rather, it recognizes why many parents adopt strategies to deal with night waking in the least conflictual manner by night feeding or co-sleeping. This may be especially true of parents who are dealing with a temperamentally more difficult infant (Blog Post 46).”

Comments

  1. Dear Dr Weissbluth, I love your content and it helps me a lot with my daughter.
    She is 4 month old and was a colicky baby. It got better after week 10 and since then I try to help her learn self-soothing skills.
    We made tremendous progress.

    In the evening, she often manages to fall asleep on her own after bath and milk. For daytime naps she needs the pacifier.
    Nap schedule is as follows: She needs a nap after 90-120 min of awake time, otherwise she will be cranky. There are no exact times, it all depends on her wake time.

    Problem for daytime naps is that in 99% of the time she wakes after exactly 30 minutes from a nap. This does not seem to be very restorative.

    Night sleep is as follows: goes to bed at around 7/7:30pm. Wakes once or twice for drinking. Sometimes I feel she wakes Not out of Hunger but is frustrated that she cannot sleep. Wakes at around 6am. Last days we suffered from early morning wakings.

    Her usual mood around 4/5 pm is nice. We usually do an early evening nap at 5.

    How can I help her? Do you happen to have an advice?
    Best regards

    1. Naps begin to become more regular and longer at 3-4 months and are highly predictable at 6 months of age in 80% of children. But for your daughter who is post-colic, regular and long naps might develop more slowly. For more information, look at the appropriate sections in my book. For now, because her naps are only 30 minutes long, think of her bedtime to be 5-5:30pm. The earlier bedtime will cause her to wake up better rested which means that naps will improve faster. The earlier bedtime might, or might not be associated with graduated extinction or extinction for night sleep. The earlier bedtime will allow you to gradually establish the first nap around 9am. Because this first nap is now more in synchrony with her developing nap rhythm, it will become more regular and longer. The book describes in detail various options for the rest of the naps. What are your thoughts about this?

  2. Thank you very much for your reply. I noticed how earlier bedtimes suit her very well, so far 6:45 is better than 7:30. I will try to skip the early evening nap at 5 pm and put her down for nights sleep as you propose. Should I try to do this gradually, ie shifting night sleep step by step earlier or just try tomorrow to put her down at 5:30 for the night?

    I already saw some consolidated 8/9am naps last week. But seldom.
    Thank you

  3. Thank you very much. After another day of bad naps (15-30min) i put her down at 6:30 drowsy but awake and she fell asleep quickly. But to our horror she woke at 10pm, 12, 2, 4, 6, spot on every 2 hours and screamed. I soothed her back since we do not have a plan for CIO in place which was not needed before. We don‘t know what happened. She always slept longer stretches. Should we continue with earlier bedtime?

    1. Biologically, you have shown that she needs an early bedtime (i put her down at 6:30 drowsy but awake and she fell asleep quickly). But post-colic children often have impaired self-soothing skills. Parents are usually exhausted after 2-4 months of coping with colic in their baby. Some of these parents now want to, and are able to quickly deal with fragmented sleep with extinction or graduated extinction. Other parents feel so depleted want to, but are unable, to deal with the new stress associated with extinction or graduated extinction and want to go slowly. Where are you?

  4. Thank you for your reply. I wanted to avoid extinction. She is so strong willed and can scream for hours. That is why I tried so hard to make her sleep in the crib and to help her fall asleep on her own. She slays had good nights with max 2 wakings. We didn’t want to interfere. But now the situation is different. I need to check the approach in your book.

  5. Dear Dr Weissbluth,

    our daughter does very well with an early bedtime as you recommended. She falls asleep easily without crying. 6:30 pm the latest seems to be her sweet spot! But she wakes up very early in the morning, 5am. This is disruptive for our family. Daytime naps are still not good. And she needs her first nap so early after 2h of awake time. Should we still stick to the early bedtime? Due to daylight saving everything has gotten more messy. Thank you!

    1. Because Nina is post-colic, there may be a slower maturation of her nap circadian rhythm. Please describe a typical schedule and duration of her naps.
      By focusing on maintaining good quality night sleep for now, eventually, her naps will improve. Better napping will then allow a later bedtime and this later bedtime will cause her to wake up later. This is a slow process, but patience will guarantee success.
      Have you tried sleeping her in a pitch-black room with a white-noise machine?

  6. Thank you very much for your reply. We will stick to the early bedtime.

    A typical schedule is hard to describe because days are so irregular depending on her naps. I will describe last night and day:

    Bath, pajamas, breastfeed, burp, to bed. Falls asleep easily after 4 minutes of babbling at 6:30. (No need for pacifier)

    Wakes at 8:30 crying, went in, resettled quickly with pacifier.

    Wakes at 1. Breastfeed. Easy continues sleeping.

    Wakes shortly before 5 in a good mood. Babbling to herself for about 10 min. Then started to cry (shout for us?). Room very dark plus sound machine. Tried to get her to sleep longer with another breastfeed, paci. But she just seemed happy and awake.

    1st nap in crib at 7:45 (needs paci) – sleeps until 8:45

    Breastfeed 9:15

    2nd nap in carrier 10:30 – 11

    Solids at 11:30
    Breastfeed at 12:30

    3rd nap in crib (needs paci) 1-1:30, tried to extend with pacifier, breastfeed, but she was wide awake and happy.

    4th nap at 3:15 didn’t work, just 10 minutes.

    5th nap in pram 4:20-4:50 pm

    Baby very tired and fussy. During the day good mood, but now seems sleep deprived.

    Solids
    Bath
    Breastfeed (always nearly falls asleep, I try to keep her awake in order to place her in crib awake)

    In bed at 7:40, very drowsy, falls asleep after few min of babbling to herself.

    For naps room is dark, but not pitch black. At night room is pitch black. White noise on for all sleeps.

    She still sleeps in our room.

    Thank you.

    1. I know that you want her to wake up in the morning later and what I advise is not logical. But here it is. For 5-10 days, do not let a nap begin after 3pm. Spend extra effort soothing and distracting and move the bedtime earlier, even at 5:30pm if needed. Naturally, you will think that she will wake up earlier and if this does consistently occur over 5-10 nights than abandon my plan. Usually the wake up time is about the same or even a bit later because she is at a lower level of neurological activation from the more sleep early in the evening. And getting better quality early evening sleep makes her better rested and when she starts the day and this will cause her to have long naps around 9am and mid-day. Once this is in place, she will then have a latter bedtime. How does this sound?

  7. Thank you so much. I will do as you advise.
    But I am a bit hesitant with not letting a nap start after 3pm. Even with her 4:20-4:50pm nap today I could have put her into bed by 6 since she seemed so overly tired. I am so happy to have a happy child around now and really the only times she still screams is when I do not let her nap in time. She is very very very intolerant to long awake times. She is not merely yawning or crying, but screaming when overtired. Hence I don’t know if she could even manage to get until 5:30 without a nap after 3pm. She usually gets very clingy after 90 min of awake time and is very ready to sleep after 2 hours.
    The alternative I am thinking about would be on a poor nap day like today to initiate her bedtime ritual right after the last nap, have her in bed by 6 and do not extend wake time like I did today to get until 6:30.

    But if your advice is to cut the last nap, I will try for the next days.
    Thank you!

  8. Ok, thank you! I will get her to bed earlier than 6:30ish and aim for 6 or earlier, no more artificial extension to achieve a 7 pm bedtime. This should not be a problem since she seems to accumulate lack of sleep and I will give her the opportunity to sleep early and hopefully restful during the night.

    Thank you very much for the helpful advice!

  9. Dear Dr. Weissbluth,

    We put our daughter down at 5:30 as you advised and she fell asleep at 5:45.
    I fed her 3x at 9:30, 1:30 and 3:30. Rather more often than usual but I figured it was ok since she skipped one awake time with feeding.
    Sometime I heard her stirring and babbling in the early morning, but apparently she fell asleep again.
    She stayed asleep and I woke her at 6:45.
    We cannot believe it!

    Today she napped at 9 for 1:10h at 12 for 38 minutes (she tried to consolidate that one too!) and again at 2:40 for 30 minutes.

    Disregarding her late wake up time, I will again skip the last nap as you proposed in order to not let a nap start after 3 – if you agree.

    Thank you so much for your valuable advice! I have my husband read your blog as you proposed. I hope we can help our daughter! Thank you!

    1. The logical assumption is that if you put your baby to bed earlier in the evening, she will wake up earlier in the morning. Biologically, often the opposite occurs. Sleep begets sleep. Exactly why did you wake her at 6:45am?

      Please stay the course. There will be good days (and nights) and some setbacks but over time the trend will be for improved sleep.
      Please keep sending progress reports.

  10. Thank you! 6:45 was our wake up time and I thought 13h in bed would be enough. If she ever sleeps in again, I will try not to wake her if you advise so.
    Thank you!

  11. Will do so if it happens again.
    Today she woke again at 4:45. Overall of course more sleep for her.
    What is your suggestion for the first nap? Always put her down after 2h when she starts to get tired or try to aim for a fixed time?

    1. There are two conflicting goals:
      1. Try to nap her around 9am and mid-day (12-2pm) +/- a third nap, if needed, that starts before 3pm. Synchronizing her nap opportunities with her biological nap rhythms makes for better quality naps. Because she might wake up very early, try to soothe and distract her in the morning in an attempt to reach around 9am. Perhaps you might get to only 8 or 8:30am. But a long nap that starts substantially earlier ( for example, at 7am) will throw off her nap schedule for the rest of the day. Similarly, try to stretch her 2nd nap to around 12-2pm, but you might get only to 11 or 11:30am.
      2. Try to avoid her getting too overtired during the day because then she will become hyper-aroused and have more difficulty falling asleep and staying asleep for a nap.

      So the degree to which you can safely extend her wakefulness to catch her biological nap rhythms will involve trial and error.
      Does this make sense to you?

  12. Thank you, this makes perfect sense and I will try to follow these guidelines. I hope she will establish a reliable nap rhythm soon. Today she took a 2h midday nap which always never happens, but apparently she needed it due to her poor catnapping.

  13. I wanted to report back: Our daughter loves her early bedtime. I always try to reach at least 6 pm, which works fine for her. She then wakes up at 6am in the morning happily. Since a few days we did not suffer from early morning wakings. We would love to have her in bed a bit later and maybe also a slightly later wake up, but we will not push it. We can see how much better she is with her early bedtime. She still does need 2 full feedings at night. Sometimes even 3. I will try to offer her more calories during the day. I think I might have been offering too much solids and not enough millk. She will turn 6 months next week. Thank you for your valuable advice.

  14. Thank you! Now that we have established an early bedtime and she does not wake too early in the morning, would you advise to extend those short 30 minutes naps? Still most of the time she only naps for 30 minutes in her crib. She does substantially extend the nap with assistance.
    Also I am wondering why she needs the pacifier at naptime but not at night. Even in the middle of the night or early morning she blew raspberries for a while and then just fell back asleep. Unthinkable at daytime.

    1. For now, I suggest that you do whatever works to maximize daytime sleep: pacifiers and extensions. As her brain matures and she develops more self-soothing, she will no longer need a pacifier during the day. Use the pacifier; it is not a ‘crutch’.

  15. Ok, thank you. I will follow your suggestion. She falls asleep in her crib but usually wakes after 30 minutes. I can easily extend her nap by taking her out of the crib, lying her next to me, giving her the pacifier and holding her hand. Usually she then drifts away and sleeps for another hour – interestingly not just 30 minutes even if I leave the room then.

  16. Dear Dr. Weissbluth,
    we are currently suffering from multiple night wakings, sometimes our baby even stays awake for a long time and cannot find its sleep again. Extinction is still no option for my husband. I try to help the baby with extra early bedtimes again. Today I put her down at 6:45 and I will do it even earlier if she needs it. Would you then propose to drop the third nap again? She usually naps araound 9 for 1.10 h and around 12:30 for 30 minutes or 1:30h if I extend the nap. She then needs a 30 minutes nap around 4.

    Kind regards

    1. She is now about 6 months old and ‘self-agency’ as described in my book develops between now and 9 months of age. ‘Self-agency’ means that she will be able to protest louder and longer if she does not get what she wants. Thus, bedtime resistance and/or night wakings will soon worsen if not corrected now. How does your husband feel about graduated extinction?

  17. He opposes leaving her to cry for now which includes graduated extinction.
    Yes, she is 6.5 months. For now she never refuses naps or bedtime. She welcomes every opportunity to sleep, though she still needs help to find sleep. She is super active, likes to play, moves a lot, very receptive to input, very strong willed. But as soon as she gets tired she gets very clingy. We think this is her problem at night as well. I also think she still needs to recover from sleep loss. Her last good night with a 7h stretch of sleep was right before our vacation.

    1. Understood.
      Because she becomes ‘clingy’ as soon as she gets tired, it is possible that you are missing drowsy cues which is very common in post-colic babies. My suggestion is to monitor intervals of wakefulness from when she wakes up and when she becomes clingy. These intervals will vary based on the duration of the previous sleep period. Then, shorten the intervals by about 10-15 minutes to see if she falls asleep easier, perhaps even drowsy but awake.
      Any nap that begins after 3pm will interfere with an early bedtime; so , please use an ultra-early bedtime if needed. Will your husband agree to this?

  18. Thank you! Yes, he will agree to that. Our daughter does manage a period of 2-2.5 h our wakefulness. I am monitoring this very closely. It is fairly easy when I am out with her in the carrier and she just shuts her eyes after 2 h max. At home I am watchful to get her to bed. I will make sure to shorten the awake time.
    But then if her last nap ends by for example 3.15pm, she currently just won’t make it until 6, but I suppose until 5:30 max. This is why I have problems with the last nap. I always have to make sure to not let her be overtired because then she screams murder.

  19. One thing I like to add: during her newborn stage she just screamed and screamed during the day. She rarely found sleep. It was very hard to get her to sleep. But she always slept 6-8h stretches during the night and just briefly fed once or twice. Now it is the reverse. It is super easy to get her to sleep (when not overtired), but she just won’t stay asleep.

  20. I wanted to report back on my now 9 months old daughter. As you said – her naps have gotten longer. She naps now twice, once in the morning around 9:30, once in the afternoon around 2. Both for 1-1.5h, but only in her bed. On the go leads to short naps.

    Now she usually goes to bed at 7:30pm and sleeps until 6am. So her nights are considerably shorter, but more consolidated! She wakes at 3-4 for one feeding.

    Her sleeping better lead to much better mood. She is a very happy baby. Thank you so much!

    But lately she starts crying whenever we leave the room and crawls after us. She still falls asleep easily and independently, but tends to have shorter naps again. We wonder whether she suffers from teething or separation anxiety.
    I suppose on an off day with again shorter naps we should offer an earlier bedtime?
    Thanks

    1. Congratulations! You and your daughter have come a long way. Please be flexible with her bedtime because of daily variability in naps. If drowsy signs are present earlier, put her to sleep anytime before 7:30pm without worrying that she will wake up in the morning too early.
      Please read the age-appropriate section in my book to appreciate how at about 9 months of age, children normally develop more ‘self-agency’, ‘stranger danger’, and ‘separation anxiety. Separately, read about the myth of teething pain. Does this help?

  21. Are you seeing any more patients? I am located in Texas but would love a consultation about my 6 month old who was colic and now never sleeps! I have tried to let her cry herself to sleep (about 20 min of crying) with an early bedtime (6:30) but she wakes up around 8 and cry’s more. I decided to leave her and let her cry again for another 20 min. Then she wakes up again around 1, 3, and 5. Literally crying all night even when I leave her. What am I doing wrong?

    1. Please describe her nap schedule.
      Please describe her mood and behavior between 5-6pm when she is alone (no screens or parental interaction).

  22. Lyla is supposed to nap 3X a day – 9, 12, 3. All lasting 1.5 hours. She will usually only sleep 45 min to 1 hour. We have a nanny that watches her weekdays and I usually instruct her to help her nap -hold her, pat her, and even do a 4th nap if the 3 naps were fast and she seems tired and it’s before 4:30 or so. I just feel so bad for her because she seems so tired some days. Her mood between 5-6 without the TV or being played with is very fussy. Admittedly, we turn the TV on at that time of day to distract her and her toddler sister. The TV seems to soothe her. Bedtime is at 6:30 but she is always acting tired and fussy I go into our room with her by 6 and she won’t fall asleep unless I’m literally holding her and she has the binky.

    1. Please read the section in my book on post-colic sleep problems to understand how you have created this sleep problem and how you can correct this sleep problem. There are several pieces to the solution and different solutions for different families. Choose a sleep solution that fits your family values.

  23. Dr. Weissbluth,
    We have decided to try extinction with Lyla. This is what we did with our first daughter and it worked well. Our first daughter has a very easy temperament so it felt easy. I plan to have a consistent night routine and an early bedtime (6 or 6:30). After reading your advice to Nina, I will not let her start a nap after 3. Naps will be 9am, 12am, and 2:30am. However she seems to be ready to nap at 8:30 some days which pushes everything earlier which will work well for the early bedtime goal.
    We started this 2 days ago. First nap she cried for almost an hour and fell asleep for 20 minutes. All naps have been that way. She has cried a lot for the last 2 nights throughout the night for 5-15 min intervals. I do not go to her unless it has been at least 4 hours. I think I’m being too strict with her since she is post colic. What do you think? Should I still assist her to fall asleep for naps? I don’t want her to get over tired. Any advice is greatly appreciated!

    1. In my nap study, which started at 6 months of age, I created 5 groups of children based on the total duration of daytime sleep (naps). Between 6 and 9 months, the group with the least daytime sleep at 6 months increased their duration of daytime sleep at 9 months of age! The other 4 groups decreased the duration of daytime sleep. I suspect that the group with the least amount of daytime sleep contained more post-colic infants. Therefore be optimistic! Separately, it is my clinical impression that the maturation of regular and longer naps is slower in post-colic infants. If this is correct, than because Lyla is about 6 months old, I would be more focused on night sleep because of the suspected immaturity of her daytime sleep rhythm. This leads me to this suggestion: Because her current naps are brief (45-60 minutes) and cries a lot at night, temporarily, consider a strict 5:30PM (falling asleep time). You do all the bathing, feeding, and soothing and walk out of the room (lights off) at 5:30 pm. If this means no 3rd nap or you need to wake her from a 3rd nap, so be it. Do extinction. Her better quality and quantity of night sleep will help her naps sequentially: first the morning nap will improve and then later the midday nap will improve. This may take several days or a few weeks. But once her naps have improved, the bedtime may comfortably be shifted to a later time based on drowsy signs. Because she is post colic, I do not suggest that you now do the ‘nap drill’ as described in my book but the ‘nap drill’ might be appropriate later. Also, read about the ‘5:30 rut’ in my book so there will be no surprises. Does this help?

  24. Hi Dr. Weissbluth, this helps so much! Thank you for the advice. I will try the 5:30 bedtime and review those sections of your book. To clarify, do I leave her all night until 7am? Or go to her once or twice if 4-6 hours have gone by? I already know she will be crying on and off all night long and it will be tempting to go to her. I want to make sure I have clear instructions to give my husband and grandparents.

    1. Extinction means you feed her when she is hungry and you go to her if you think she is in any distress, otherwise, she is left alone. Because of her early bedtime, you might be starting the day around 5-6am but not before. Please review, and make your husband read, the section on ‘Extinction’ for other pointers.

  25. Hi Dr. Weissbluth! To give you an update, Lyla has been having 8-10 hour stretches at night, has a bottle, and goes right back to bed. Naps are still short. Like you said those are slower to regulate so I’ll be patient. Thank you for all the help!!!

  26. Hi Dr Weissbluth! Even though Lyla is sleeping much better at night, after 20 or so minutes of crying. She is still not doing well with naps. They still usually only last 30- 45 minutes unless you are holding her the entire time. Should we start leaving her to cry for the naps as well? We are trying to do 3 naps a day. If she take a bad first nap then sometimes we hold her for the second or third so she doesn’t get over tired. What do you suggest we do?

    1. Look at the big picture:
      Lyla is post-colic; she is now about 7 months old.
      You have 2 children.
      You have a nanny responsible for naps on week-days.
      Night sleep is improved but she still cries about 20 minutes before falling asleep.
      Here are my suggestions:
      1.Temporarily, because naps are problematic, temporarily move the falling asleep time 20 minutes earlier. Monitor latency to sleep and crying.
      2.Because night sleep has improved, proceed with the ‘Nap Drill’ (page 289) in my book. Start today and don’t allow the Nanny to deviate.
      3. Because of her age, only try for 2 naps (mid-morning and mid-day); depending on her naps, the bedtime might actually have to be 5:30pm for a while.
      4. When naps improve (expect the morning nap to improve before the midday nap), her bedtime may be moved to a later time, based on drowsy signs.
      Let me know your thoughts and if you proceed, report back in 4-5 days.

  27. Hi Dr Weissbluth!
    The nap drill plan seems to have backfired. We started this on Tuesday and today is Sunday. We were shooting for 2 naps a day with a 5:30/6 bedtime. She has been crying so much for naps (sometimes an hour each nap) but never sleeps more than 30 min if she sleeps. I try and leave her for an additional 30 min but she just plays and babbles and eventually starts to cry. Before this she was sleeping well at night. Since we started the nap drill, she wakes up constantly at night. I believe this is because she is so overtired from all the crying during the day. She is almost 8 months so she can cry for a long time!

    That being said for the last 5 days or so she has only slept a total of 1 hour per day for naps with several hours of crying.

    Last night I rocked her to sleep because I felt like she was so tired and stressed. She fell asleep instantly by 5:45 and then woke up at 10pm and cried for 2 hours and we couldn’t console her. That hasn’t happened since she was colic. I think it’s because she is very tired. It’s so hard to find the balance of keeping her well rested and leaving her to learn to sleep on her own.

    What do you suggest I do? Instincts tell me I should let her cry again only for night sleep with a 5:30 bedtime while rocking her to sleep for naps. Might even do 3 naps per day so she can become rested again. Even though her naps will be short, she will have that early bedtime to help make up for it. Like you said, maybe her naps will get longer as she gets older.

    Did I give you too soon or is it more important to get her back to a well rested state?

    Thank you so much for any advice. Your methods worked so well with my first and I am confident I can get Lyla on the right track!

    1. “Instincts tell me I should let her cry again only for night sleep with a 5:30 bedtime while rocking her to sleep for naps. Might even do 3 naps per day so she can become rested again.”
      I agree with you, trust your instincts. Do whatever you can to maximize day sleep and minimize day crying. For now, focus on night sleep with early bedtimes +/- extinction. When she is better rested, at least several days from now, maybe in a week or two or even later, consider trying the nap drill again. When I used to do a lot of sleep consults, a plan would sometimes fail, the family would stop, take a break, get everyone to a better rested state, try again, and usually be successful on the second trial. So please be optimistic! I wish I could be more specific on when to try this again but specific family circumstances vary so much, trust your heart. Because of your experience with your first-born, please remember that in no way has your daughter been harmed.

  28. Hi Dr. Weissbluth! Thank you for all your past advice. Lyla is 10 months old and is doing much better! She is putting herself to sleep for naps and bedtime. She doesn’t even cry!

    She sleeps about 11-12 hours with one night waking, occasionally two night wakings. However, if there is a second night waking, it only takes a pat on the chest and putting binky in her mouth, and she falls back to sleep immediately.

    She is having two naps. Usually one nap is only 30-40 minutes. The other nap will be 1-1.5 hours. Occasionally she can have a bad day and have two 30 minute naps. Those days, I put her to bed as early as 5:30 and she will sleep 13 hours sometimes. She seems to be pretty happy but I can tell she is over tired during the day. When she wakes from naps early, we leave her for 10-15 minutes until she starts to cry. Any suggestions on how to extend her naps? I am confident if we keep her rested at night, keep an early bedtime, and keep letting her out herself to sleep, they will start to get longer.

    I also wanted to mention that she has had 2 febrile seizures in the last month. We all keep getting sick with basic colds and the two times she has gotten a fever, she has had a seizure. I mention this because I was curious to see if you have seen any correlation between colic and/or sleep deprivation, and febrile seizures. She is getting more sleep than ever before, so it doesn’t seem like she is sleep deprived. However, with the colic and the lack of soothing skills, she was definitely sleep deprived at the beginning of her life.

    1. I did a literature search and could not find an association between febrile seizures and a past history of colic and/or sleep deprivation.
      My suggestion is to try to deliberately and consistently shorten the interval of wakefulness before a nap by just 10-15 minutes for 3-5 days (or longer if needed) to see if it helps eliminate the occasional short nap. Also consider a white noise machine and making the room pitch black. Please let me know if this helps.
      Also, please consider writing a narrative report of Lyla’s sleep journey and post it here for me to anonymously use it as a Blog Post. Your voice will resonate with some mothers better than mine.

  29. Dr. Weissbluth,

    I am a first time father of a son born at 39 weeks and is almost 8 weeks old. He is still battling the tail end of colic but has improved so much. He was inconsolable most of the day and night from birth but now is happy and smiling other than his evening “witching hour”. The witching hour seems to be decreasing in severity and was even absent a couple of days ago but still makes nights a roller coaster. I read your book and my wife and I are eagerly implementing your advice. We definitely have fostered some contact sleeping habits when we were doing anything we could to survive. We have avoided comfort feeding and gastrointestinal symptoms. We are now wanting to start using “drowsy but awake”. Our son has such bad contact sleep associations, I’m not sure how to go about it. I can get him drowsy after our bedtime routine by bouncing on a yoga ball briefly and then set him in his bassinet. He either fussed until he cries or sleeps only briefly. Is the idea to keep picking him up, rinse and repeat, until he finally sleeps from a drowsy state? If so, anticipating his sleep being short, do I hang out and wait a short amount of time for the chance that he will self soothe until he falls back asleep and then restart the drowsy but awake process? I am off of work for a while with my wife and we can take shifts and try to get him as many drowsy but awake “reps” as possible. We want to use extinction method once colic has fully abated and want to give him the tools to enhance chances of success. Your book has been incredibly helpful and the only source of comfort for us (colic and fussiness information backed by experience and data). Thank you for what you do.

    1. Please describe a common pattern of sleep during the day and a common time that you begin your bedtime routine. What is a common time for him to fall asleep at night, how often does he awaken at night, and how many times is he fed at night?

  30. Doctor:

    Here is the trend from the past couple of days:

    • 7:30 AM – 9:00 AM: Wake-up, Breastfeed & Play
    • 9:00 AM – 10:35 AM: Nap Routine [sleep sack, white noise, blackout shades] & Nap [Put down awake lying next to one of us]
    • 10:35 AM – 12:15 AM: Breastfeed & Play
    • 12:15 PM – 2:00 PM: Nap Routine [sleep sack, white noise, blackout shades] & Nap [Put down awake lying next to one of us]
    • 2:00 PM – 3:30 PM: Breastfeed & Play
    • 3:30 PM – 4:30 PM: Nap Routine [sleep sack, white noise, blackout shades] & Nap [Put down awake lying next to one of us]
    • 4:30 PM – 5:45 PM: Breastfeed & Play
    • 5:45 PM – 6:15 PM: Cat Nap in carrier
    • 6:15 PM – 7:30 PM: Breastfeed, Quick Bath & Bedtime Routine
    • 7:30 PM – 8:30 PM: Night Sleep [Put down awake lying next to one of us]
    • For +/- 1 hour – from dead sleep he wakes up with inconsolable crying and falls back asleep after
    • 9:30 PM – 10:15 PM: Feed
    • 10:15 PM – 1:45 AM: Night Sleep [Put down awake lying next to one of us]
    • 1:45 AM – 2:30 AM: Feed
    • 2:30 AM – 5:00 AM: Night Sleep [Put down awake lying next to one of us]
    • Wakes up here with gastrointestinal symptoms (so far, the only time of day he experiences them) // I put him on my chest and he gets through it pretty fast.
    • 5:00 AM – 5:30 AM: Feed
    • Struggles to go back to sleep
    • 6:00 AM – 7:30 AM: Broken Sleep

    Some notes:
    ++ I find it interesting that the timing of the nightly colic crying and the morning stomach issues to align with your theory of a correlation between these events and circadian rhythm / melatonin / cortisol / serotonin.
    ++ All sleep, other than the short carrier nap is co-sleeping (not our original plan). My wife or I put him next to us awake and he will fall asleep quickly. We do this for naps too, to take advantage of motionless sleep. I will say, that once we did this instead of car/carrier/rocking/walking his mood has improved. We do not want to continue co-sleeping any longer than we have to, but did it out of desperation.
    ++ I’ve watch him possibly self soothing (considering we put him down next to us awake). This includes sucking his hand (just started) and moving his body and rubbing his face at the beginning of sleep and between sleep cycles. He sometimes fusses, cries lightly for a minute or two.

    Thank you!

    1. Thank you for your detailed notes. Because of colic and his corrected age (about 7 weeks), my suggestion for now is to change only one item. For 4-5 nights, do everything that you currently do except attempt to have a night sleep start at 7:00pm (or earlier) even though there is a cat nap between 5:45-6:15pm. Alternatively, think of night sleep beginning at 5:45 and do the night sleep routine then as if you expected night sleep to begin then, that is, do bathing, feeding, soothing for night sleep and expect him to fall asleep for a few hours starting at 5:45pm. Expect to feed him about four or more hours later and again 4 or more hours after the first night feeding and then again in the early morning hours. Our goal is to have night sleep start at an earlier time without changing other sleep-related routines. The earlier, the better. Does this make sense?

  31. One more thing. We have been staying next to him the whole sleep duration because he wakes in very short order if we leave.

  32. Good morning! We have been inching bedtime earlier (7:15 night 1 and 6:30 night 2). I will have more to report on the nights soon, but so far so good. Only issue is he has started protesting as soon as we enter into his nap routine and cries at a 2.5 out of 3, sometimes for more than 10 minutes. He also doesn’t stay asleep very long. We are already contact napping so the only thing I can think to do to protect naps is exclusive carrier naps. Thank you and appreciate any advice.

    1. Because of his age, the main focus is on night sleep. for now. The earlier bedtime will allow him to wake up better rested and eventually take better naps (starting around 3-4 months of age). When better rested, you will see more drowsy signs. Experiment with shortening the interval of wakefulness before a nap by about 10-20 minutes to see if he goes down easier for a nap (although naps might continue to be brief and irregular). Does this help?

  33. I should add that we are waiting for the typical drowsy signs before naps. Yawning, less interest in playing, less kicking of his legs are the ones we’ve observed.

  34. Doctor,

    We have successfully pulled bedtime earlier over the last four nights, and have seen the following results:

    NIGHT 1
    • Sleep 1 ~ 7:15 pm – 9:50 pm
    • Colic Witching Hour ~ 8:05 pm – 8:11 pm
    • Feed 1 ~ 9:50 pm – 10:50 pm
    • Sleep 2 ~ 11:00 pm – 2:30 am
    • Feed 2 ~ 2:30 am – 3:45 am
    • Sleep 3 ~ 4:00 am – 6:50 am
    • Feed 3 ~ 6:50 am – 7:40 am

    NIGHT 2
    • Sleep 1 ~ 6:35 pm – 8:25 pm
    • Feed 1 ~ 8:25 pm – 9:05 pm (fed to try to stop/soothe witching hour)
    • Colic Witching Hour ~ 9:05 pm – 10:15 pm
    • Sleep 2 ~ 10:15 pm – 2:10 pm
    • Feed 2 ~ 2:10 am – 3:10 am
    • Sleep 3 ~ 3:20 am – 6:20 am
    • Feed 3 ~ 6:20 am – 7:15 am

    NIGHT 3
    • Sleep 1 ~ 5:50 pm – 6:25 pm
    • Colic Witching Hour ~ 6:25 pm – 7:00 pm
    • Sleep 1.1 ~ 7:00 pm to 9:05 pm
    • Feed 1 ~ 9:05 pm – 10:05 pm
    • Sleep 2 ~ 10:15 pm to 12:40 am
    • Feed 2 ~ 12:40 am to 1:45 am
    • Sleep 3 ~ 1:50 am to 5:30 am
    • Feed 3 ~ 5:30 am to 6:20 am

    NIGHT 4
    • Sleep 1 ~ 6:00 pm to 10:30 pm <– longest sleep stretch ever
    ~ No colic witching hour!
    • Feed 1 ~ 10:30 pm to 11:25 pm
    • Sleep 2 ~ 11:25 pm to 2:20 am
    • Feed 2 ~ 2:25 am to 3:25 am
    • Sleep 3 ~ 3:30 am to 6:30 am
    • Feed 3 ~ 6:40 am to 7:40 am

    Some notes:
    + we had our longest sleep stretch ever last night!
    + we are protecting naps (carrier or contact naps) but they have decreased in length. He doesn't seem to have any fatigue issues during the day, however.
    + we do not start a nap after 3:00 pm
    + we are still co-sleeping

    We feel the early bedtime is a great move! Please let us know any comments/changes/next steps you suggest. Thank you so much for your help.

  35. Hi Doctor,

    Sorry to bombard with questions. We have had a lot of success with early bedtime. The last four days and so far today have been like clockwork in terms of schedule (it’s actually to the minute many times). Witching hour and early morning stomach issues/restlessness seem to be improving. He rarely cries at all and has a very happy demeanor during awake periods … gone are the days of all day crying.

    • Awake and feed at 7 am
    • Nap 1: 45 minutes at 8:30 am followed by feed
    • Nap 2: 2 hours at 11:30 am followed by feed
    • Nap 3: 1 hour at 3:00 am followed by feed
    • Bedtime routine & feed
    • Asleep at 6:00 pm
    • 1st stretch 4.5 hours followed by feed
    • 2nd stretch 3.5 hours followed by feed
    • 3rd stretch 2 hours followed by feed
    • Awake a 7 am

    I’ve re-read sections of your book and am trying to gently nudge him towards some self-soothing skills (only contact naps and family bed with contact so far have him sleeping). I understand his colic has delayed the development of self-soothing. He doesn’t do drowsy but awake, but we try for one nap a day and one sleep stretch a night and just pick him up if it doesn’t take (allow a little fussiness but no serious crying). I also try to rock him to deep sleep and set him in the bassinet but he awakes within 5 minutes. We are doing early bedtime, many hands, many naps. I was thinking we: (1) wait for the peak fussiness period to end by monitoring witching hour, and general fussiness, (2) keep working with the strategies from your book for post-colic babies as mentioned above and anticipate extinction over a weekend past 3 months of age in the future (if he doesn’t develop self-soothing with our current drowsy but awake attempts).

    Does it sound like I’m on the right track here? Thank you and happy new year.

    1. Congratulations!! You have made enormous progress in a fairly short period of time. Remind me, what is his corrected age?

  36. Thank you and thank you for your help. We got a lot more out the book re-read because we weren’t so exhausted, haha. He will be 9 weeks, 8 weeks adjusted tomorrow (1/8).

    1. Because of your progress and his age (colic is gone in 50% of infants by 8 weeks, an additional 30% by 3 months), begin to think about using a sleep solution, perhaps at night only (because night sleep becomes more organized around 6 weeks of age) to encourage self-soothing. Maybe try this, with a 5:30pm expected falling asleep time for only 3-5 nights to see if it works. If it fails, go back to your current style for a while longer. In no way will you have harmed your child. If you are uncomfortable with this idea now, simply stay the course and reconsider in the future. If you do it and are successful at bedtime, then I will advise you how to proceed with naps. let me know your thoughts.

  37. Doctor,

    My wife and I would like to try a sleep solution soon. We had a couple of questions.

    • He has a little bit of colicky symptoms still. Should we await for these to fully abate?

    • If we chose extinction with no cap, what would constitute failure? Or do you suggest a cap for an early attempt at this sleep solution to allow us to deem it a success/failure?

    Thank you!

    1. The specific circumstances of your each family (support, copping ability, comfort with extinction, etc.) means that you are best able to decide when to try a sleep solution.
      With extinction with no cap and a strict 5:30pm falling asleep time, fussing/crying at sleep onset should dramatically be less and less over 3-5 nights. The failure to see this occur might mean that you should abandon the effort (after 3-5 nights) now (perhaps colicky issues are still present) and try again later. Please let me know what you decide and how it goes.

  38. Hello Doctor,

    Thank you, your response was so helpful in us reaching a decision. We know that we need to teach our boy to self-soothe. What we are doing now is not sustainable and we would like to move forward with extinction with no cap if that offers all of us better sleep and health. My mother will be in town this weekend to support us and I finally have his nursery done, so we want to give it a go starting on Saturday. We are nervous, but armed with the knowledge that this will not harm our son, we have all committed to giving it our best shot.

    We do have a round of vaccinations on the 16th and my wife wanted me to ask if you think those would in any way impact our result if the training is successful?

    Thank you again for your support. You have been a godsend.

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