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

Found in age groups

Healthy Sleep Habits, Happy Child

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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.

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