Healthy Sleep Habits, Happy Child
69
My Opinion, #2
March 7, 2022

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.

Blog 69My Opinion, #2

My Opinion:

The most common cause of sleep problems in young children is a bedtime that is too late.

This is my opinion, based on my general clinical pediatric practice over 40 years, my many sleep consultations, my own research, and reviewing published scientific papers. Additionally, data shows that there is a long-standing trend towards later bedtimes that causes a decrease in total sleep duration. As more and more infants and children become short on sleep, they have more difficulties falling asleep and staying asleep through the night. Here is the data:

What is an Early Bedtime?

Bedtimes have become later and later. This trend began a long time ago. Here are data showing bedtime (PM) by age:

Age    1974  1979 1986  2011-2015  
6 months 7:18 7:41  8:16 8:54
1 year 7:08 7:35 7:46 8:39
2 years 7:08 8:07 8:54

The trend towards later bedtimes means that the total sleep duration has decreased. Here are data showing total sleep duration (hours) by age:

Age    1979-1980 2004 2011-2015
1 year 13.8 13.4 12.8
2 years 12.8 11.9

Data specific for Spain shows the same trend towards decreased total sleep duration (hours) over time:

Age    1987 2011
2.5 years 10.7 10.3
6-9 years 9.9 9.5
10-14 years 9.3 8.9

As described in Blog Post 6, small differences in sleep duration can produce major consequences over time.

My published research, in 1982, shows that moving the bedtime to an earlier hour dramatically reduces the number of night wakings and the time interval between being put down to sleep and actually falling asleep (sleep latency). To accomplish the earlier bedtime, the parents woke her every morning at 7AM and did not permit afternoon naps. This tactic of ‘controlling the wake-up time’ has mostly been discussed in the adult literature in the context of ‘chronotherapy’, that is, resetting the circadian clock. Although this tactic is effective, it is not well known in pediatrics.  For example, my paper has been cited only once, in 1993.

In 1999, a study of children 2 to 5 years of age showed that the later bedtimes were associated with shorter night sleep duration. Less sleep at night was associated with behavior problems even when short night sleep is associated with longer and more frequent naps such that 24-hour sleep duration is normal.

In a 2020 study, objective measurements, using sleep actigraphs at 6, 15, and 24 weeks showed that “Infants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.”

A separate study in 2020, using objective measurements, found that at 3, 6, and 13 months, “that infants with later sleep times had less nighttime sleep.” They did not wake up later.

So, no matter your child’s age,  when you consider early bedtimes (Blog Posts 7 and 22) and use drowsy signs (Blog Post 9), don’t be shocked if your child goes to bed much earlier than your friends’ children. Their late bedtimes might be very common but being common is not the same as being healthy. Today, commonly occurring bedtimes might be too late, and unhealthy, for most children.

WHAT IS YOUR OPINION? HAVE YOU EVER TRIED AN EARLIER BEDTIME? SUBSCRIBE TO MY SLEEP ADVICE BLOG FOR MORE CONTENT LIKE THIS.

Comments

  1. Hi Dr. Weissbluth,
    Your book was a huge help when my 5 and 7 year old kids were babies. Now I have a nine week old, and he’s the hardest one yet. He’s the first that I’m able to nurse. He will not take a bottle or paci even though we have tried from the beginning. From two weeks on, he wouldn’t sleep for more than a minute, so we got Dr. Harvey Karp’s Snoo and that helped a lot. I am careful to put him to sleep within 1-2 hours of wakefulness. In the morning he goes down while awake for 1-2 naps in the moving Snoo, but after that he needs to be nursed to sleep. For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream. His weight is very good according to the pediatrician. He’s in the 55th percentile. When he turned 7 weeks he only nursed in the evenings for hours but then started sleeping five hours straight, usually from around 2am-7am. Then he got his 8 week vaccines and started nursing all night again. I am at a loss of what to do. The pediatrician said it’s okay if he cries a little, but I’m not sure what that means. Do I just wait this out until 12 weeks? My husband cannot help me with the baby because he’s taking care of the bigger ones. The bigger ones feel like I’m not with them at all and I feel horrible. Do you have any guidance for me? Please!
    Ariella

    1. What are the most common times that he falls asleep during the day and at night? How many times do you attend to him at night and is it just for feeding?

  2. His schedule is still very irregular… he usually falls asleep around 8/9am, then around 12/1pm, then around 3pm. After that he often takes 1-2 more naps. When he’s been very fussy he’s skipped those evening naps. The morning naps are sometimes longer, sometimes 2-3 hours. But sometimes in the morning he eats and sleeps every two hours, like 6, 8, and 10am. As the day goes on the naps get shorter, sometimes 1- 2 hours and sometimes 30 minutes.
    At night he was falling asleep between 1:00 and 3:00 a.m. after nursing for hours straight, then waking up at 6:00 or 7: 00am. But now he’ll just keep nursing sometimes again the entire night until 5:00 or 6:00 a.m. Last night he nursed from 11pm/12am until 3:30 a.m. and then woke up at 6:20 a.m.
    He usually nurses to sleep before his naps. After trying unsuccessfully twice to do that this last nap, I let him cry for 15 minutes and he fell asleep. Is that something I should try in the evening/ night? He is much fussier in the evening and night and I’m afraid it won’t work or that the crying will be much more intense.
    In the night my attendance to him is just for nursing and changing diapers and burping.. But that does go on for hours and hours. I don’t think he can be hungry for so long but I don’t know how to deal with the crying if I stop nursing him. And I don’t know how much to nurse him so that he’s not hungry.
    Thank you so so much!
    Ariella

    1. “For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream.” Children with colic often are like this and your narrative description.. Blog Posts 43 and 44 might clarify whether colic is or is not creating the stressful situation that you are dealing with. I suspect that this is so because you are an experienced mother and have tried carefully to help your baby sleep well. If you think that your baby might have colic, please read the section in my book on colic and how to prevent post-colic sleep problems. If you think that your baby does not have colic, then other sleep solutions might be appropriate now. Please let me know your thoughts.

  3. Dr. Weissbluth,
    I have a 12 week old who usually goes to bed at 8 pm. Based on her drowsy cues, I think she could go to sleep earlier (maybe 7) but it is still light out where we live and my husband believes this would throw her off. We could blackout her room but of course there would still be some natural light in the house and bathroom where she bathes as part of her nighttime routine. What are your thoughts? Can night sleep start when it’s still light?

    1. Please read, and have your husband read, Blog Posts 23 (How to motivate a parent) and 62 (I learned to stay on the schedule in order to avoid fighting with circadian rhythms.
      I concluded that I won’t win that fight, but my baby would lose!) to convince your husband that you have the correct viewpoint. Let me know how it goes.

  4. Thank you, Dr. Weissbluth. I just reread your section on colic (I’ve actually been reading it over and over these last few weeks) and the two blog posts you mentioned. Yes, I do believe my baby has colic. I got a confused, though, because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later after his vaccines. Can that still be colic? Everything else seems to point to it.
    Based on your book, it seems I have to wait it out until 3-4 months, is that so? Is there anything I can do? I’m exhausted.
    The baby falls asleep on me while he’s nursing and I fall asleep too, sometimes, with him lying on top of me. It feels unsafe.
    Thank you again!
    Ariella

    1. Colic ends in 50% of children at about 2 months of age, 30% at 3 months, and 10-20% at 4 months. ” because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later” suggests that colic was winding down around 7 weeks but because the brain wants an earlier bedtime around 6 weeks of age, he accumulated a sleep debt from a too late bedtime and over a week his sleep again worsened. Consider now a 5-day trial of any sleep solution you wish to prevent post-colic sleep problems, but definitely include a much earlier bedtime. Perhaps the two older children distracted you from implementing an appropriate early bedtime when he was younger. Let me know how it goes.

  5. Hi Dr Weissbluth,

    The baby has slept the last four nights! Thank G-d. I did as you suggested and put him to bed earlier with lights out, between 9:00 and 11:00 p.m. I didn’t even have to let him cry, just nursed him first. The first two nights I also gave him Tylenol as per the pediatrician, as he thought the baby might be still reacting from his shots from the week before when the sleeping problems all started again. I hadn’t been putting him to bed earlier because he showed no signs of drowsiness at night and was just fussy and demanding nursing. But so far now he has been sleeping 5-7 hours and then waking up once around 4 or 5am and going back to sleep. Thank you so, so much for all your help! I feel like I am finally coming out of this nightmare.

    One more question… I used to wake my other babies up by 7:00 a.m. to keep them on schedule. Right now this baby is waking up at 8:00 or 9:00 a.m. Am I supposed to start waking him up at 7:00? I feel like we are both catching up on so much lost sleep.
    Thank you again!!

    1. Your baby’s brain will want an even earlier bedtime soon, so continue to gradually move the bedtime earlier. This will automatically cause the wake-up time in the morning to move toward 7ish. If this gradual approach fails, then maybe go ahead and wake him to get naps around mid-morning and mid-day and a bedtime that is early. Let me know what you do.
      Sweet Dreams,
      Marc

  6. Dear Dr Weissbluth,

    I wanted to update you… I tried to move the bedtime earlier in the weeks after we were last in touch, but the baby insisted on nursing 4-6 hours in the evenings, and then he would sleep 7-8 hours straight at night. He would go to bed between 10pm and 12am and wakeup at 6am or 7am (which was so nice after barely sleeping those first few months!:)), so at least his wakeup time had shifted naturally to an earlier time.

    He is now 15 weeks (born a week early). This last week he started going to bed earlier, between 9pm and 10:30pm, though he started waking up again in the night just to eat, anywhere between 1am and 5am. He has a cold and I’m hoping that’s why he is waking again, but I guess regardless his bedtime is earlier, which is good. His evening nursing marathons got shorter and less intense, more like one session of 2-3 hours, with more breaks, right before bedtime.

    I know he probably should be going to bed even earlier, but if I put him down before his evening nursing marathon is over then he’ll scream, but when I let him do his thing then I know when he’s done, as he’ll suddenly stop and go to sleep, and then he sleeps well after that.

    His naps are still not scheduled or condensed, as he sleeps 45-60 minutes usually and occasionally 2 hours, but at least he still sleeps within 1-2 hours of wakefulness (besides for that one evening nursing marathon before bed).

    Thank you again so much for all your help and advice!!

    1. The effect of colic on night sleep is much less after 3-4 months. If you are comfortable with this, every few weeks, try a 4-5 day trial of a much earlier bedtime and a night-time sleep solution of your choice.

      The effect of colic on day sleep consolidation and regularity might last until 4-6 months of age. Your main challenge now is to do your best to keep him well rested during the day in the face of caring for two older children who might have scheduled activities. The better he sleeps during the day, the better he will sleep at night and vice versa.

      Congratulations on coping with colic. I think the worst is over. Please try to enlist as much help as you can for naps and night sleep. Please take breaks without guilt! Breaks for you are smart for the family, not selfish. Please give me a follow up.

      Sweet dreams,
      DrW.

  7. Dear Dr Weissbluth,

    I’m nervous to sleep train, but I know it’s probably the right thing to do… I will see how it goes.

    Yes, we make napping a top priority after reading your book! It definitely helps.

    Thank you so much for all the help and advice!! I will give a follow up.

  8. Hi there, my 8 week old ( born on due date). Is a pretty easy going baby minimal crying and naps/ sleeps decently. She can go down drowsy and about 50% of the time will fall asleep on her own. However sometimes she will start to cry, we have been reading your book and see you suggest letting them cry before sleep? Is this okay to do with an 8 week old? How long should we let this happen? Is it for naps and bedtime? She usually wakes up 1-2 times a night and has shown she can go 4-6 hours at night. Also her bedtime is still late 9-10 we have tried to move it earlier but she wakes up after an hour or two and treats it like a nap, how do we move bedtime earlier so she’ll treat it as nighttime? Thank you so much!

    1. Individualized advice for your family depends on many variables. My suggestion is to read the following topics on my Blog and tell me which variables are most salient to consider.
      1. Drowsy signs (Blog Posts 9 and 83)
      2. Parents (Blog Post 17 and 18)
      3. Sleep training (Blog Posts 57 and 67)
      4. Make Bedtime earlier (Blog Post 74)
      5. Bedtime routines (Blog Posts 10 and 87)
      Parents’ reports
      #1. Graduated extinction and extinction (by age of child)
      #2. Early bedtimes (by age of child)

      Please let me know your thoughts.
      Sweet Dreams,
      Marc

  9. Hello Dr. Weissbluth,

    I have read your book numerous times and have employed your methodology successfully for my first 2 children. I wish I had used your methods and advice for my first child sooner. He was a horrible sleeper and finally, around the 15/16 month mark, the pediatrician recommended reading your book. Within 3 nights, our son was sleeping better. For my second son, we employed your methods and strategies early and he has been such a great sleeper. There are hiccups along the way but for the most part, both have been good sleepers. My 3rd child has been a challenge. We were unable to employ your methods earlier on with her. We needed more help with our daughter (grandparents helped to take care of her but refused to listen to us) and unfortunately, that meant inconsistency. My parents (grandparents) have now left and our daughter is 17 months now. We employed your methods and it’s been well over a week now. Unfortunately, we are not having the same success as with our first 2. She will still take about 15 minutes to soothe herself to sleep. Like clockwork, she will wake up around 1:30 am. It
    Takes anywhere from 30 to 45 minutes for her to soothe herself to sleep. She will then sleep again until around 5:30 a.m. at that point, it is off and on until around 7:30, which is when our 2 boys wake up. Do you have any suggestions?

    1. Is it possible that your 3rd child at 17months has been chronically a little short on sleep and/or fragmented sleep?
      What is her current nap pattern?
      How does she behave and feel around 4-5pm?
      Please describe a typical bedtime and bedtime routine and 1:30am routine.
      Is your husband available early in the evening and on week-ends to help?

  10. Dear Dr Weissbluth,

    I wanted to give you an update, but was embarrassed because the baby’s sleeping had been not great at all and I’m still scared to sleep train. He is now 6 months. To be fair, we had been moving a lot this summer while we did work on our house, and then he got sick a few times, and each time any of those events happened he didn’t sleep well for about a week.

    We finally moved back home two weeks ago, and he finally fell into a routine. He still goes to bed late, around 9/10pm, and then he wakes up between 12am and 2am and then again around 4/5am. He has 3 naps a day, and the first two are often long. His last, short nap is around 4/5pm, and if I try to hold him out to skip it, he’ll just take it at 7pm and go to bed later.

    Our focus with this baby is to keep him as well rested as we can. People comment that he is such a happy, calm baby, and they can’t believe he is the same child as the screaming baby he was the first 3 months.

    Two issues I have now are that the first time he wakes up at night, he eats and then goes back to sleep pretty quickly. He’s usually still sleeping mostly. I usually fall asleep while he’s nursing and put him back an hour later. Then the second time he wakes up, he seems very uncomfortable after he eats and has so many burps and spits up. Once he gets all the burps out, he goes back to sleep happily, but that can take two hours sometimes. I wonder if that’s because we are both sleeping the first wakeup and he eats for too long. He also has a lot of burps/reflux throughout the day, though.

    He also seems to want to go to bed at night earlier but wakes up with burps and can’t stay asleep until he gets them all out.

    The other issue is that he still sleeps in the Snoo, which is a bassinet that has a swaddle attached to keep him from rolling over. If his arms are unswaddled, he wakes himself up by hitting his head. He sleeps much better and much longer while swaddled. Right now he doesn’t roll over, but he is outgrowing the bassinet and then I will be unable to swaddle him any longer, as it will be unsafe.

    I really appreciate all the help, kind words, and advice you have given throughout these difficult few months.

    1. I know that there are many variables influencing your baby’s sleep. Please focus on two main issues:
      1. The bedtime is too late.
      2. When you fall asleep nursing your baby, there is the potential for harm to come to you or your baby.
      Please consider a Community Sleep Consultant (Blog Post 27) to help you help your child sleep well. The failure to move the bedtime earlier and his dependency on the Snoo guarantee future major sleep problems. To correct your unhealthy sleep deprivation and to protect your baby’s neurodevelopment, now is the time to make major changes. Please let me know how it goes.
      Sweet Dreams, DrW

  11. Dear Dr Weissbluth,
    Ok, thank you again for your advice. We built the crib today and will try to make some serious changes over the weekend and next week. I will also consider a sleep consultant.
    Hopefully I can update you soon with good news.
    Thank you!!
    Ariella

  12. Hello Dr. Weissbluth,

    Thank you for your response! My husband helps a lot on the evenings and weekends. It is just the 2 of us and both of us are working professionals. We rely on daycare for help during the day now.

    I do think she is either chronically short on sleep or has fragmented sleep.

    At daycare, she naps anywhere from 45 minutes to 2.5 hours. It’s usually around the 1-1.5 hour mark. The daycare turns off the lights, plays music, and then pats the children on the back until they fall asleep. On the weekends, we try for 2 naps but she is slowly going to 1 nap. Getting her to nap is a bit of a challenge.

    Around 4-5 pm, she is fine. She plays and is very happy.

    Ideally, I would like to get her to sleep earlier. Our first was in bed around 7 pm. When our second was born, it was harder to do that and bed times ranged from 7:30-8:00. Now that we have 3 (oldest just turned 5, middle just turned 3, and youngest at 17 months), bedtime is usually around 8:00 – 9:00. She is usually asleep around 8:10 with the boys falling asleep on their own between 8:30-9:00 (sometimes later if they fall asleep on the way home and develop a second wind).

    The typical bedtime routine is dinner, bath, short story, then bed. I have weaned her so that she does not nurse to sleep. After the story, I say goodnight and she waves goodnight to her brothers. I then take her to her crib and she snuggles against me and then I place her in the crib. I say goodnight and close the door. She then whines and cries but does fall asleep.

    At 1:30 am, she wakes up. She will whine and cry for about 30-45 minutes. I have not gone in to her room. She will fall asleep again but I am surprised that she is still doing this.

    For the past 2 nights, I have tried for an earlier bedtime for her but it was not successful. In fact, it took her longer to fall asleep and in the end, she ended up falling asleep at around 8:10 to 8:30. I think a significant factor is that her 2 older brothers are up still and she can hear them playing or taking a bath. We try telling them to be quieter but they are toddlers still so that has limited success. In an ideal world, I would love for all 3 to go to bed earlier.

    Regards,
    Christina

    1. Your daughter is usually asleep around 8:10pm. What time do you you usually enter your home after picking up your daughter from daycare? What time does her usual bedtime routine begin? How long does her bedtime routine last? After you leave the room, how long does she whine and cry before falling asleep? What time was the new earlier bedtime for the past 2 nights? Please describe how she sleeps day and night on week-ends.

      What is the time in the late afternoon or early evening when all 5 are you together? What time do all of you usually sit down together for dinner?

  13. Hello Dr. Weissbluth,

    We usually get home between 5:00 and 5:30 (depending on traffic) and that’s for all 5 of us. Dinner starts anywhere between 6:00-6:30 (sometimes at 6:45) depending on if we have dinner prepared already or are making dinner. We take turns with making dinner. Ideally, we like to have dinner at 6 but honestly, it sometimes takes a while to get her brothers to stop playing and sit at the table with us. Bath is right after that and is usually around the 7:15 to 7:30 mark. I guess the bath is part of the bedtime routine and lasts about 5-10 minutes. Then the drying her off, diaper, PJs, and sleep sack is about another 5 minutes. Story is less than 5 minutes. Snuggles and placing her in the crib is also less than 5 minutes. After I leave the room, she whines and cries less than 15 minute minutes. The first night was the worst and each subsequent night was about 15 minutes or less.

    The last 2 nights (and tonight so this is the 3rd night), I tried for an earlier bedtime so we made a concerted effort to have dinner early and start bath early. I basically gave her a bath earlier than her brothers and did bedtime routine a bit earlier than her brothers. Last night, she was in her crib around 7:30 but it took her a lot longer to go to bed and she ended up falling asleep later than her usual time of 8:10 (I think because she could hear her brothers). However, last night, she did not wake up at 1:30 a.m. and woke up a bit later, whined for less than 30 minutes and then, slept all the way until about 7:30 a.m. Today, it was the same thing and I knew she was tired. Even though we pushed things earlier, she fell asleep at 8:03 (a few minutes earlier than her normal 8:10).

    On weekends, I try for 2 naps. She wakes up between 7:00 a.m. to 7:30 a.m. Then around the 9:00/9:30 mark, I try to get her to nap and if unsuccessful, then I try again around 11:30 a.m./noon (which is when her daycare has nap times). If she does take a morning nap, then I try for a mid-afternoon nap around 1:00/1:30/2:00. Her naps range anywhere from 1 hour to 2 hours. Night routines on the weekend are basically the same times as the weekday routine.

    1. CONGRATULATIONS! You have accomplished a lot in just a few days.
      Before: ” Like clockwork, she will wake up around 1:30 am.” “Takes anywhere from 30 to 45 minutes for her to soothe herself to sleep.”
      Now: ” last night, she did not wake up at 1:30 a.m. and woke up a bit later, whined for less than 30 minutes and then, slept all the way until about 7:30 a.m” “After I leave the room, she whines and cries less than 15 minute minutes.”

      Please stay the course! As described on my Blog, just a few minutes per night of extra sleep will make a huge difference over time. Here are my suggestions which may, or may not, be compatible with your life-style:
      Because of her age, try for one mid-day nap on weekends and a super early bedtime based on drowsy signs (the time will vary because of variability of the nap and physical activities); even as early as 5:30pm.
      Brainstorm with your husband on how to make an early dinner easier to accomplish. Perhaps make a plan to prepare week-day dinners ahead of time. Maybe this will be a fun week-end family activity to do a lot of menu-making, prep, cooking, and storing!

      Going forward, it will take weeks to repay her chronic sleep deprivation debt. Please be patient. But once this is accomplished, she will be able to comfortably tolerated occasionally staying up much later for exceptional events (a few times per month) and possibly skipping a week-end nap (perhaps add on a super early bedtime).
      How do you and your husband feel about what you have been through these past few days?
      Sweet Dreams,
      DrW.

  14. Hello Dr. Weissbluth,

    Thank you. That night was the anomaly unfortunately. The subsequent night where she went to bed a bit earlier at 8:03 was rough. She woke up at 1:30 am again and then proceeded to wake up and cry throughout the night. Last night, I was able to get her into her crib at 7:08 but she did not go to sleep right away and fell asleep around 8:40. She then woke up at 4:00 am and did not go back to sleep. We will continue to try and incorporate what you have suggested.

    Regards,
    Christina

  15. Hi Dr Weissbluth,
    We’ve made a little progress, the baby is out of the Snoo and his arms are not swaddled anymore. He naps in his crib. My question is, his naps before when he was in the Snoo seemed consolidated for at least a month or so. Now that his arms are not swaddled, his naps are usually 45 minutes, sometimes 1 hour, which is less. My oldest baby had colic as well, and she did not start consolidating her naps until after 8 months. This baby is 6 months. Is it possible that he needs more time to consolidate now that he is in a regular sleeping environment? Or the fact that he had consolidated already in the Snoo means that he doesn’t?
    Thank you!
    Ariella

    1. In my nap study, at 6 months of age, I divided infants into 5 groups based on the total duration of their naps. The briefest nap group, 1-2.5 hours, had a mean nap duration of 2.3 hours per day. I suspect that infants who had colic were overrepresented in this group.

      At 9 months of age, the mean daily duration of naps in the other 4 groups decreased, but those infants who had been in the briefest group now had longer naps (2.7 hours per day)!

      This observation supports your suspicion based on your first child that it takes longer for naps to develop in post-colic infants. This has been my experience also.

      So please be optimistic that naps will improve. However, sometimes, an older sibling distracts a parent from observing drowsy signs in their baby or an older child has too many late scheduled activities with the result that the baby’s bedtime is too often too late or the baby experiences skipped naps because of the older siblings scheduled daytime activities. The result is a baby that continues to struggle with day sleep, night sleep, or both.

      Please give me a progress report.

      Sweet dreams,
      DrW.

  16. Dear Dr Weissbluth,

    Thank you for your reply!

    Ok, we will continue to make his sleep a priority and be optimistic that the naps will consolidate.

    Thank you again!

    Ariella

  17. Dr. Weissbluth,
    I am reading your book again for the second time with my son. I read it with my daughter at about 12 weeks as she was always a good night time sleeper but an awful napper. My son is an awful nighttime sleeper and an awful napper, but we and making some progress. He is currently 13 weeks old, but was born 5 days overdue. He initially was quite fussy for the first 6-8 weeks ( almost colicky ), but I initially had a breast milk supply issue and I think 8 pm was too late of a bedtime for him. We moved his bedtime to between 630 and 7 and he goes to bed now most of the time with very little crying, however, he is quite fidgety between 5 and 6 pm every night. My issue now is nighttime awakenings and restlessness in the night.We also had a period of poor weight again and so I am always nervous that my milk supply is low . For the last week he gets a bottle of formula between 6 and 615 ( I still breastfeed during the day with the occasional formula top up) and then we perform the bedtime routine of brushing gums, put on pjs and story. He is in bed always before 7pm. My concerns is he never consistently wakes up at a certain time, sometime he signals at 11pm, sometimes 12:30 and occasionally he goes until 1:30 am. He the wakes again between 4-5 AM. I never know if I should be getting up to feed him at 11 or is this just a signal for attention? I have also tried using the pacifier until it is after midnight but I do not want to get into the habit of giving him the pacifier to go back to sleep and in the back of my mind I am remembering his poor weight gain days and I question my milk supply. During the day he goes down well for most naps but they are generally only 45 minutes in length and he takes 4 per day. He does squirm a lot in his sleep and make quite a bit of noise. I am breastfeeding him in the night but he sleeps in his crib in a nearby room. Do you have any tips for me? I am thinking that if he had longer naps then the night awakenings would decrease or should his bedtime be even earlier than 645-ish? I have been trying to hold on to breastfeeding as long as possible for it benefits but in particular the decreased risk of SIDS ( I have read SIDS most often occurs between 2-4 months of age).

    1. A common problem with the second child is that the first child interferes with the parents’ recognition of drowsy signs and the need for an early bedtime starting at about 6 weeks of age.
      “he is quite fidgety between 5 and 6 pm every night.” tells you that his sleep tank is nearing empty. Thus, the “bedtime to between 630 and 7” is way too late.
      The suggestion is to not allow any naps to start after 3pm and begin your bedtime activities (bathing, changing, feeding, soothing) so that at 5:30pm you are waking out of the room (lights off). The earlier bedtime will improve the quality of naps between 4-6 months of age and after this occurs, the bedtime will naturally become a bit later.
      How does this sound?

  18. Thank you Dr. Weissbluth! I started moving his bedtime earlier by 15-20 minutes. Once he started going to bed at 6pm (not a minute later) his naps lengthened (now he naps for 1.5 to 2 hours in at 9 am; the afternoon nap is around 1 hr to 1.5 hours; and about a 30-45 min catnap at 3:45) and his signalling around 9 or 10 pm at night has stopped! Everyone in our house is so much happier and well rested.

  19. Dr. Weissbluth,

    We have had initial improvement in both night sleep and naps, however, it seems that my son has taken a step back in his progression. He is now 15 weeks old and for the last 2 nights he has been sleeping from 6 pm until 1:30 am- 2 am, without signaling. I generally wake up and feed him at this point; he is usually stirring but not fully awake. He will then wake again around 5:30 in the morning for another feeding and then goes back to bed. I have been waking him around 7:30- 7:45. His night time sleep has become much better! However, we had initially achieved 1&1/2 to even 2 hours naps for his morning nap (at 9 am) , and now he is waking fully at about 35 minutes. I leave him in his crib for a full 1 hour, he often is awake for a full 10 minutes and then he shows drowsy signs (thumb sucking, eyes look drowsy – we have a video monitor) but he just can’t fully commit to sleep. He often ends up crying within this hour and this morning he ended up having a full on fit and was inconsolable for a while. I think he needed to sleep longer but he just couldn’t connect his sleep cycles. We do use extinction as a self soothing technique and often his crying his less than 10 minutes (for example with his nighttime sleep). I just am not sure if the reason he cannot nap longer right now is because he is overtired or not tired enough? Any thoughts? Thank you in advance your advice is always appreciated!

    1. Night sleep sounds great. Congratulations! Nap rhythms begin around 4 months of age and become regular and longer between then and about 6 months of age. Because he is so young, I suggest that you do not wake him in the morning and nap him when drowsy signs appear during the day. Let me know, if you do this, how it works, or not.

  20. Hi Dr. Weissbluth,
    I do feel that my son’s nap rhythms have begun to develop. He will be 4 months this Sunday and he was overdue by 5 days. Unfortunately my son has now come down with a severe cold- I am doing all I can to help him with saline, nasal suction, and Tylenol. His nighttime sleep has now worsened and I have now thrown extinction out the window because I feel a soother helps him sleep better but it keeps falling out and needs to be replaced. During times of illness is it ok to waiver from your plan ? In your experience will this put you back at square one? Also, I feel like right now my son is napping longer in the morning than he normally will, therefore, his afternoon nap is pushed back as well as his late day nap; should I push his bedtime back or should I try and skip the 3rd nap to keep him with the early bedtime of 530-6? Thanks again for any advice you have.

    1. When ill, forget sleep schedules and care for your son. Common colds usually last 3-10 days but the worst is over after 24-72 hours although mild symptoms may linger to day 5 through 10. If you feel comfortable and perhaps in consultation with your child’s primary care giver, when the severe symptoms have gone away, back to boot camp regarding sleep. Early bedtimes will always help to get back in the groove.

  21. Hi Dr Weissbluth,
    In follow up from my last comment, my son has now recovered from his cold/respiratory infection. As I am writing this I am back to practicing extinction for his 12:00 nap. He has been having very fragmented nighttime sleep with lots of waking/signalling. For the past 3 night we have put him to bed at 530 pm. He signals typically around 630 and usually 2 or 3 more times before I breastfeed him between 11:50 and 2 am depending on when he wakes. He then wakes again 3 hours after the previous feeding like clock work, and then he will usually wake up between 6:30-715 in the morning. Just this morning he had a great 9 am nap of 1 and 1/2 hours without having any waking. Now for his 12:00 nap I started my soothing routine about 15 min before 12:00 with his diaper change and he started to have an overtired meltdown. I put him in his crib at 12:00 and he has cried for 12 minutes but is still having on and off crying. I will be leaving him in his room for 1 hour before getting him up. I feel like he is not having any great sleep at this point. Please do you have any advice? I trying to be optimistic that things will change soon. He is now 4 months 4 days.

    1. Do you use drowsy signs or clock time to put him down for naps?
      At night, I understand that you feed him once’ correct?
      Are you doing extinction, graduated extinction, or soothing him between bedtime and before and after the single feeding?

  22. I feed him twice in the night, once between 11:50 pm and 2 am and then a second time which occurs 3 -4hours after the first nighttime feed. I use extinction. I generally watch his drowsy signs but also the clock; I try to follow the nap drill as in your book.I aim for 9,12 and 3 but will put him down sooner depending on his drowsy cues. Sometime he wakes from his nap crying, even if the nap was 1.5 hrs); I am assuming this is sleep inertia. Generally he goes down for sleep quite well ( this afternoon was an exception), so he can self soothe to sleep well, but he definitely has problems staying asleep. With his nighttime awakenings/signalling I let him self soothe back to sleep but since it happens up to 3 times per night plus his awakenings it is very disruptive to my sleep. Again, thank you for your help.

    1. What is the most common fall asleep time at night?
      Please describe, in detail, his moon and behavior during the hour before that time when he is unattended and alone with toys (not being soothed, held, entertained, or in front of a screen).

  23. Well the last 4 nights (including today) he fell asleep within 10 minutes I would say; so anywhere from 525-545 pm. He is usually in good spirits until about 430 ( he wakes from his 3 pm nap between 330 and 345)but then we start to get him ready for bed. After 430 I would describe him as irritable and fidgety if you are not holding him or entertaining him. I feed him a bottle of formula starting at about 455-5pm and by then he is getting so fussy he can’t drink the bottle without crying. I then breastfeed him for a bit after the bottle (I do this because I am concerned about my milk supply dipping at this time and I don’t think I have enough milk for him so I do the formula first to ensure he gets at least 4 oz – that is what he usually drinks from the bottle). I then brush his gums read him a story or two (depending on what he tolerates depending on fussing) then he is in bed. Should I be moving his bedtime earlier than 5:30 pm? One time he did have long nap at 3 pm which lasted until 4pm and the current bedtime routine went extremely well; however, I am generally not successful at getting him to extend the 3 pm nap.

    1. Because of not napping well, “After 430 I would describe him as irritable and fidgety if you are not holding him or entertaining him.” If you move the bedtime earlier:
      1. He might get more sleep at night, wake up. better rested, have better naps, and eventually you’ll be able to shift the bedtime later.
      2. He might wake up earlier so that there is no net gain in night sleep duration and no improvement in naps or with more consolidated night sleep, he might wake up better rested and item 1 occurs.

      Perhaps try an earlier bedtime (5:00pm) starting tonight (Friday night so your husband is available during the daytime for help) and monitor his naps, mood, and behavior for a three night trial to see what happens. Perhaps before you start, read about the ‘5:30pm Rut’ in my book to anticipate a possible problem with my suggestion.

  24. Hi Dr. Weissbluth,

    Thank you so much for your speedy responses and helpful advice. Last night my son slept from 525pm-116 am without any crying/signals (this was wonderful). He fed at 116 and then slept again until 4:30 am for his second feeding. He then awoke at 547 am. I left him in his crib to see if he would go back to sleep, but I don’t think he did so I got him up for the day around 640 am. Overall I would say this is one of his best sleeps to date! This morning I put him down for his first nap at 8:00 am as he started to act restless and even suck his thumb (he went down without any crying or resistance). I will take your advice about moving the bedtime to 5:00 pm if his napping is poor and I will try 5:30 if things are going well (I will try and do a balancing act between the two times depending on nap and sleep quality). I will also reread the section in your book on the 5:30 rut as I believe we will face some problems in the future. I will likely try this immediately as my husband works shift work and is away every other week. I do have some questions for you.
    #1) How do you deal with sleep inertia and naps – this morning he went down at 8:00 Am; he awoke at 8:57 screaming. I am assuming this is sleep inertia? I tried to sneak into his room and use a soother to get him to continue to sleep but no such luck. Even after picking him up he was still crying. He really gets very upset. When babies awake from a nap crying loudly is there a best course of action? I am assuming this is why you say in your nap drill to try and get your child to the 9 am and 12 pm times if you can ,to align with circadian rhythms. Although Jackson has had an hour nap this morning was this nap likely “junk sleep” since it wasn’t aligned with his circadian rhythm?
    #2) When you are attempting a nap drill should you let your child go over the 2 hour mark of waking if he doesn’t seem fussy/tired ? ( in my current situation I doubt I would have this scenario). This morning I felt he started to show signs of restlessness at 9:57. So I put him back down to sleep. He did fuss more for about 8 minutes but fell asleep after that. I am wondering if I should have waited longer to put him down, but I know he would have not made it anywhere close to 12:00 pm.

    Thank you so much for all of your help. It really is the only thing keeping me optimistic that things will improve.

    1. I completely agree with your overall plan. Let’s hope the improved night sleep continues. If night sleep continues to improve, eventually you will be more able to get to a midmorning and mid-day nap.
      #1) Based on your past experience, the duration and timing of the nap, the intensity of the crying, follow your heart to go immediately or delay your response.
      #2) The 2 hour mark is a usual ceiling and because night sleep is just starting to get better, it’s better to have a too short interval of wakefulness than a too long internal of wakefulness. As night sleep improves, slowly, very slowly try to stretch his morning nap closer to about 9am. When that is accomplished, try to slowly stretch his midday nap towards 12-2pm.
      Improvement will be sequential: first night sleep, than the midmorning nap, and then the midday nap.
      Please send me a progress report in a few days.
      Sweet Dreams,
      DrW

  25. Dr. Weissbluth,

    It has been about a week since my last question and we have had huge improvements! After having the initial improvement in night sleep he did have a little relapse 3 nights later where he awoke in the early morning and stayed awake for about 1 hour and 45 minutes. He didn’t cry at this time so we just left him fall back to sleep on his own. His naps have now improved in that he is going 2 hours between waking and his morning nap and 2 hours between his morning and afternoon nap; the naps are about 1 hr 15 min to 1 hr 30 minutes in length. We have not had any bad episodes of sleep inertia in this last week and his bedtime has been able to stretch to about 5:45 pm. Knock on wood, but life is good these days! Thank you so much for all your help.

    1. Congratulations! Please resist the temptation to gradually push his bedtime later or he will develop cumulative sleepiness and relapse. When an event or illness causes him to not sleep well for a night or two, try a ‘reset’ as described in my book.
      Please consider writing a narrative report regarding your sons transition from not sleeping well to his improvement that I would publish as a Blog Post. If so, you could post it here.
      Sweet Dreams,
      DrW

  26. We are definitely going to keep the bedtime early just vary within 15 min to half an hour depending on his wake up time from his last nap. I will definitely make a write up on my son’s sleep problems and post it here within the next few days. Thanks again.

  27. Hi Dr Weissbluth,

    Here is my narrative on Jackson’s sleep problems and the progress we have made so far. Hope you can use it.

    When you are expecting your second child, you think it will be easier raising the second compared to raising your first because you are now an “experienced” parent. This thought is wrong. I knew with Jackson, our second child, I was going to do things differently. I had read Dr. Weissbluth’s book, “Healthy Sleep Habits, Happy Child” with our daughter when she was 3 months old, after she became fussy due to not having a nap routine. Our daughter had always been a good nighttime sleeper; she slept from 8:00 pm to 4:00 am at only 8 weeks. However, she needed help learning to nap. After I read Dr. Weissbluth’s book, she did learn this skill. Now, with our son, I knew the skills to help him sleep: I needed to put him down drowsy but awake, he needed to have a regular bedtime routine, he would take all his naps in his crib, and he needed an early bedtime between 6-8 pm (we chose 7 pm initially). These practices were started on day 1 home from the hospital. Our first 6 weeks home were spent going to appointments every 2-3 days due to poor weight gain and a likely milk supply issue. Jackson also became very fussy from 2 weeks to 6 weeks of age and unfortunately, he remained fussy until 3-4 months of age. I believe he would fit the definition of colic (crying more than 3 hours per day, at least 3 days out of the week). During this time, we tried to let Jackson learn to self soothe but, as I am sure most parents of fussy children do, we found this challenging. After Jackson’s weight gain was on track (around 2 & ½ to 3 months) we decided it was time to work on his sleep. Previously, I had been going into his room to breastfeed him anytime he awoke from his sleep thinking he must be hungry since he was slow to gain weight at the beginning. When Jackson was about 16 weeks old, I knew that he was suffering from a lack of sleep. We often would have bedtime battles with him; he would be so fussy around 6-6:30 pm that he could not even breastfeed nor drink a bottle of formula. He would have multiple night awakenings and he would awaken from his naps with almost hysterical crying (this was likely sleep inertia). His nighttime awakenings would occur every 2-3 hours some nights and he would have difficulty settling back to sleep even after he was fed. His naps during this time were also quite short in duration, usually around 45 minutes. At this time, I was exhausted, and I didn’t know what I was doing wrong. I had moved his bedtime to 6:00-6:30 pm on my own after re-reading Dr. Weissbluth’s book, which suggests 6-8 pm. Despite all our efforts, Jackson was fussy and not sleeping nor napping well. I reached out online to Dr. Weissbluth through his website. He suggested an earlier bedtime yet, 5:30 pm, as Jackson’s behavior between 4-5 pm indicated he needed more sleep. I ended up moving his bedtime between 5:30-6:00 pm, which showed some success by minimizing some of the night awakenings. Illness then swept through our house, infecting all of us, which interrupted our sleep training. Dr Weissbluth advised to focus on caring for our son and halt sleep training until he was healthy. After Jackson had recovered from his cold, he was again waking multiple times in the night and even had an episode of crying on and off for 1 & ½ hours one night (from 10:30 pm- midnight). I again reached out to Dr. Weissbluth, who suggested an even earlier bedtime of 5:00 pm- 5:30 pm, depending on the quality and timing of his last nap and his behavior between 4-5pm. Dr. Weissbluth also suggested watching Jackson for drowsy signs and napping him when they appeared rather than watching the clock. This was especially important while his nap rhythms were not yet developed. After about a week of extra early bedtimes (5:00 pm-5:30 pm), Jackson’s night awakenings resolved. His naps also significantly improved; he is now napping for about 1 and ½ hours in the morning and midday, with a 45-55 min late afternoon nap. Jackson would be described as an “irregular” child. It has taken a long time for him to develop napping and feeding schedules; and within these schedules, there is quite a bit of variance. Therefore, the advice that Dr Weissbluth gives, to “watch your child for drowsy cues” is so important. I feel that we really struggled with this early on due to Jackson’s colic; it is hard to catch drowsy/fussy queues when your child is constantly fussing. Everyone in our house now is much happier and better rested. Jackson currently goes to bed around 5:30-5:45 pm and he is asleep within 10 minutes. He wakes once in the night, around 2:30 am to feed, but doesn’t cry. His wake up time isn’t consistent yet, but is somewhere between 5:30-6:45 am. I do not go in to him until it is past 6:00 am. I am so grateful for the help that Dr. Weissbluth provided during a very stressful and tiresome time in my life. I have learnt that early bedtimes and watching and responding to your child’s sleep cues are of utmost importance in sleep training.

    -Tara Marsh

  28. You can leave the names.
    P.s you were right with pushing the bedtime. We have had 2 night with awakening at 10 pm. So we are going back to 5:15-530 pm bedtime. He just seemed to be in such a good mood between 4 and 5 that I thought he was ready. I am confident though he will get back on track.

    1. Thank you, Tara. Would it be possible to add a little to the narrative about how you felt during these past several weeks and the role of your husband during this time?

  29. Dr. Weissbluth,

    Here is a continuation of my narrative that you may use.

    For the past 4 months, I feel like I have been failing as a parent. I have been very frustrated that I am unable to help my son be less fussy and sleep better. I was, and still am, very anxious, especially at night time. I am always concerned that I am going to miss his drowsy cues and put him to sleep too late, contributing to more bedtime battles and night time awakenings. However, with each night that he does sleep better, I gain confidence that I am learning to read his cues better, and I am providing him with the right environment and schedule to become better rested. Having a supportive partner does make sleep training much easier. My husband works away 50% of the time, and therefore, I do 100% of the bedtime routines for consistency. When he is home I do find the whole process of sleep training easier and he helps me by providing emotional support. He was skeptical at first of the ultra early bedtime, but once we had some success with it he was in agreement with it. My husband is not a book worm, therefore, reading Dr. Weissbluth’s book was not appealing to him. However, Dr. Weissbluth’s website, which contains the same information as his book, was a handy resource that my husband was willing to read. Overall, my anxiety is improving slowly, and I am more optimistic each day that my son will some day sleep 12 hours without waking up.

    I now have another question for you. I am sorry if I am taking up too much of your time.
    (1) So after having a blip of 2 nights with awakenings, I had put my son to bed at 5:15 two nights ago and he slept well with only the 1 awakening at his feeding time. He was sleeping by 5:25 that night. Last night I tried to repeat the whole process but it did not go as smoothly. His nap must have not been as restful and/or I was a couple of minutes later feeding him, but he developed a fussy period and had difficulties drinking his bottle which then put the whole process about 10 minutes later or so. He was in bed at 527 pm and sleeping by about 538. He then awoke last night briefly at 11:10 and I believe he went back to sleep quite quickly, then he awoke again at 12:45, this time I believe he fell back to sleep around 1:15, but then awoke again 145 am at this time I got up to feed him as it was close enough to 2 pm. My question is, if I child is hungry can that prevent them from self soothing back to a deep sleep? I know you say hunger is not a factor in waking up but what about returning to sleep? I feel that Jackson likely did not sleep well between the period of 1245 -1:45 as he was likely in and out of light sleep. I am hesitant to feed him earlier than 2 am because I am afraid it will result in more awakenings and more feedings in the night as I am concerned my milk supply isn’t as great as the 6 oz bottle I give him at 5 pm before going to bed. I will start to transition him to another formula bottle in the night if you think it will help him if I feed him earlier on in the night (ie: if I would have gotten up to feed him at 12:45 instead of making him wait until 1:45 am). Again, I feel like a failing parent as I still feel I don’t know how to recognize when my son is actually hungry. With a fussy baby I am used to him crying all the time and I don’t know when the cries are because of hunger or fatigue.

    (2) In your book it states that it takes about 5 days more or less for children to learn the process of extinction. I am just wondering how come it is taking so long for my son to return to sleep when I consistently do not go in to him at night except for the one time to feed. Am I expecting too much from Jackson and that this process just takes longer? Or is it just likely that he is still in a sleep deficit (this is probably the case).

    (3) If my anxiety is related to Jackson’s sleep problems and my own sleep deficit should I be taking to my doctor about treatment as it could be hindering the process of sleeping. Prior to having Jackson I would say I was not as anxious as I am now and that the majority of my anxiety is caused by his sleep problems. However, I really do want to fix his sleep problems and if my anxiety is causing the issue I do want to treat it.

    Again thank you for all your help.

    1. Thank you for this detailed report. How strong is your desire to continue breast feeding or do you have thoughts regarding when you would like to stop breast feeding? If you have a strong desire to continue breast feeding now and for a while longer, have you met with a lactation consultant? Your answers might make my response below inappropriate but here are some suggestions that might be helpful.
      1) Hunger will cause your child to awaken and if you suspect your child is hungry at night, promptly feed him. The correct interpretation regarding the relationship between night feeding and sleep is that in a child who is not hungry, feeding more, as in ‘topping off’ or ‘dream feeds’ will not produce more sleep. It is possible that your breast milk supply sometimes at the end of the day is diminished and the 6oz bottle is not enough so sometimes he is hungry earlier in the night. If so, the solutions might be steps to increase your breast milk supply or to stop limiting the amount in the bottle.
      2) Please clarify, excluding the feeding, how often does he cry out at night (episodes per night and nightly occurrences per week)? What is a common duration of the crying episode? Approximately, what is the breakdown (%) of intense, moderate, and mild crying? If offering more bottle feeding or enhanced breast feeding eliminates or dramatically reduces this crying, then we might conclude that it was due to unappreciated hunger. Depending on your responses to my above questions, you might want to consider a 4-5 night trial of offering an 8oz bottle to see if the crying is less.
      3) Research strongly suggests that the most common relationship between maternal anxiety and children not sleeping well is bidirectional. Please read the sections in my book regarding the ‘the infant path’ and the ‘maternal path’ to better appreciate how the infant or the mother might be the main factor. Additionally, I wish to compliment you on your insight into your anxiety. As a father of four sons (ages 44-56) I can easily state the obvious: there will be unpredictable challenges ahead for you as a mother, a wife, and as an individual. Meeting with a professional now to deal with your anxiety will benefit you now and help you cope in the future. Psychiatrists, psychologists, social workers, come in different flavors but they all have the potential to enhance the quality of your life.

  30. Thank you so much Dr. Weissbluth,
    Your response’s definitely are not inappropriate. Right now I am continuing to breastfeed because my focus is on Jackson’s sleep and meeting his sleep needs. If giving up breastfeeding will help with that then that is the path I will take. The funny thing is last night I started our bedtime routine earlier at 4:50; Jackson did not seem overly fussy at this time but started to fuss once feeding commenced. He drank only 2 oz of formula and then, I and my mother who is here to support me while my husband is working away, came to the conclusion that maybe he just isn’t hungry. I then put him to bed at 5:20 and he was sleeping at 5:32 pm. Jackson then slept right until 230 am without a single awakening! (He then fed and went back to sleep within about 30min and awoke for the day at 5:45) Of course I did not sleep at this time because I kept expecting him to wake up because he was hungry (he I only had 2 oz of formula compared to 6 oz). So now I am wondering if my bedtime battles are because I am trying to force feed my son? It is hard to forget that your child has been gaining weight well when you start with poor weight gains. I am going to continue with my 5:15-5:30 bedtime and not be too concerned with the amount of formula left in the bottle. I have also put my name on a list to see a counsellor regarding postpartum anxiety. I will definitely re-read those sections in your book regarding “the mother path” and the “infant path”. Thank you for all your help! We have made improvements with his sleep and I always need to keep that in mind; we have come a long way in the last 4 weeks. I do keep a track of night awakenings but I am going to see how the next couple weeks go and I will track intensity of crying and number of times per night and per week. Thank you again!

  31. Dr. Weissbluth, I promised myself I would not reach out for help again so quickly, but here I am. It is 430 am and I have not had much sleep since about 10:10 last night. Here is what happened last night. I tired spacing jackson’s feeds differently so he would be more hungry around 5 pm. He breastfed at 1:40 and then I started bedtime routine at 4;45pm with the bottle. Again he drank maybe an ounce or ounce and a half. He should be hungry at this time since it has been over 3 hours since his last feed. I changed to a faster flowing nipple and reheated the bottle and he drank the full 6 oz without complaining. I then Put him to the breast for any top up he would like. He was sound asleep by 5:30 without any bedtime battles. He then cried out at 10:10. This was short and minimal maybe 2-3 minutes in length. He then cried at about 11:15, again short lived and then cried out again at 12:30. I consulted with my mom and we both felt that he didn’t necessarily sound hungry but something must be bothering him. We decided I would go in and change his diaper. It was soaking wet, which is typical when he drinks the bottle (but different from the previous night when he slept so well but drank 2 oz before bed). I did breastfeed him at this time because he cried hard after the diaper change. He fell back to sleep quickly but then awoke at 3:30. I didn’t go in to feed him as I felt the cries were not hard and he was just fed at 12:30-1245. He did go back to sleep but then woke up again now around 4;00 am with talking/chatter/restlessness. At this point my thoughts are there is something wrong. Is the formula causing him problems? Or is the restlessness early on in the night caused by a wet diaper which then contributes to more awakenings? By some small miracle do you still do individual appointments that I would be able to book with you? I feel like I really need to make serious changes now. If not, do you know of someone who you could refer me too. I also plan on making an appointment with my GP for Jackson. Things are just not making sense to me anymore.

    1. Does Jackson sleep in the same room with you? If not, do you have a monitor to hear him? How old is he?
      My general suggestion is today (Sunday) to take a break from all of this and so some serious self-care; take some time for yourself: manicure, pedicure, massage, go exercise (yoga, biking,…), get outside and do some mindful breathing (on my Website: More for Parents) or meditating. Everything will soon settle out.
      Focus on the big picture, not night by night. Remember, he has great self-soothing skills!
      Forget feeding schedules, if you feel that he is hungry, feed him. If you are uncertain, have your husband or mother offer a bottle: The volume and speed of this bottle feeding will clarify whether he was really hungry. Nothing is wrong with the formula.

  32. Ok thank you! I agree he does have great self soothing skills as he really does try to put himself as back to sleep. Jackson is 4 months 3 weeks old today. He sleeps in a near by room. I use a monitor but have the volume off most of the time as I can hear him just fine with his door left just ajar.

    1. Please throw away the monitor and close the door. Your sleeping brain is sensitive to Jackson’s distress sounds and you do not need to have your sleep disturbed by his non-distress sounds.
      Naps become organized between 4-6 months so your expectation is that longer and more regular naps will develop and thus his bedtime will become more regular and perhaps a little later.

  33. Hi Dr Weissbluth,

    Since I last took your advice I would say things have gotten better. I do believe that my son possibly was more hungry than I thought and I also believe he may have had a dislike/milk protein allergy or intolerance to the formula I was using. Since your last post I have switched formulas and I am in the process of switching to formula feeding (although this does make me sad). Jackson’s nights have improved as he no longer is waking with whimpering/crying. When he does wake it is more than 4-6 hours after his last feed so I am thinking he is hungry. Last night was the first time I bottle fed him at night and he consumed about 5 oz quickly so I knew he was hungry. My question for you now is this: when the midday nap is pushed back, should I also push the 3rd nap back or should I try to skip the third nap to keep an early bedtime (he is 5 months old today and was born 4 days overdue)? Yesterday Jackson woke up at 5am. He had been in his crib sleeping since 530 with only 1 waking for a feed so when he woke at 5:00 to eat I was pretty sure he was wide awake. We decided to start the day. He managed to stay awake until 815 am (and was in pretty good spirits). He napped for 2 hours and 20 minutes. His midday nap then started at 12:45 and lasted about 45 min. Jackson did not seem drowsy really at 3:00 pm ( as he was only awake from 1:30-3 pm) ( I watched him very closely he was just sitting in his bumbo chair, although he did have a pacifier). I knew that he would not make it to 530 if he didn’t have a nap in between 1:30-5:30. I thought he maybe started to fuss around 3:45 so I put him down. He maybe slept for 15-20 minutes and was up for 4:05. I know that a nap is not restorative unless it is at least 30 minutes. Unfortunately Jackson crashed on me at 5:05pm; he seemed content (but maybe drowsy) from 4-5 pm, but I knew it was going down hill after he started to cry/fuss hard when I went to set him down after putting on his PJs. I tried to do the bottle and bedtime routine quickly but he was full on crying hard to I just put him in his crib and he was asleep within 5-10 minutes. He then awoke crying at about 6 pm. I decided I would try to feed him and do his bedtime routine and put him back to bed; I don’t think he was very hungry because he only took about 2 oz of the bottle, but after the quick bedtime routine he did self settle back to sleep within about 20 minutes. He then awoke at 11 pm to eat ( I breastfed at this time as I felt “full”), but at 3 am for the next time he awoke I felt “empty”, so he got the bottle and drank the 5 oz at that time.

    1. Congratulations! Please stay focused on his night sleep improvement: “Jackson’s nights have improved as he no longer is waking with whimpering/crying.”
      Day sleep gradually develops and becomes more regular by 4-6 months of age. Blog Post 119 describes how some variability in naps and changes in naps occur at and after 6 months of age.
      “My question for you now is this: when the midday nap is pushed back, should I also push the 3rd nap back or should I try to skip the third nap to keep an early bedtime (he is 5 months old today and was born 4 days overdue)?” Avoid a late third nap and cope with extra soothing and distraction to get through an unsettled late afternoon and keep an early bedtime. An early bedtime is always preferable to a late bedtime.

  34. Hi Dr Weissbluth, when you mean an early bedtime, are you referring to the 530 bedtime? Yesterday Jackson’s morning and midday naps were both about 1 hr 20 min each. I had not yet heard back from you so we napped him at 4pm and got him up promptly at 435 once he started to stir. We then did the nighttime routine and had him in bed for 605 pm and he was sleeping at 615. He awoke between 12:30-1am; I let him stir until he started to cry so I fed him at 1am where he drank a 5 oz bottle and then breastfeed too. He returned to sleep promptly. He then made a noise around 3 am ( I think he maybe pooped himself at this time) but he went back to sleep immediately, he then awoke at 518 but went back to sleep until 615 am. My concern with dropping the third nap is that if his midday nap ends between 1:30-2, then he is up for an extremely long period of time to make it until 5-530. I will check out the blog post that you suggested.

    1. In general, having a nap that starts after 3pm will eventually lead to a late bedtime that will cause more bedtime battles and more night awakenings. This fragmented night sleep will then mess up his naps.
      There are always exceptions to a general plan. Real life means that 100% consistency is not the goal. When there is an early and/or brief mid-morning nap and/or an early and/or brief mid-day nap, you might put your child down for a third nap anytime before about 3pm and let him sleep as long as he needs. Depending on the timing and duration of this 3rd nap, the bedtime still might be early (5:30ish) or later.
      Does this help?

  35. I just read the blog post, I think what I gathered from reading that is if he is drowsy at 4pm it may be ok to nap him as long as we don’t extend it too much, if he does t seem drowsy at 4 pm and he resists that nap I should be prepared to have him in bed by 5-515 ? Again it is just watching my child and trying to catch the drowsy cues, which is what I have had difficulty with previously.

    1. “Again it is just watching my child and trying to catch the drowsy cues, which is what I have had difficulty with previously.” Yes.
      The older he gets, the more you want to avoid a third late afternoon nap.

  36. Hi Dr. Weissbluth,
    Just wanted to thank you again for all your help and support you have given me. Jackson is now almost 7 months ( on May 5 he will be) , and he sleeps about 11 hours each night. I did take your advice and hired a sleep consultant from the family sleep institute. She didn’t have to change much from what I was already doing but she did convince me to cut out one of my nighttime feedings and then about 4 or 5 days later Jackson cut out the second nighttime feed on his own. One thing we still battle with is early mornings. Jackson wakes up at about 5 am, give or take 15 min. Every day. The sleep consultant felt I was putting him to bed too early ( at 5:30). She wanted me to nap him around 4:30 each day and have a bedtime of 6:30 or 7 pm. I tried this for a few days but found that it was a struggle for him to fall asleep and he still was waking around 530 am. I didn’t really agree with this strategy after our conversations, as well as other references I have read state not to have a nap go over 430 pm. To compromise I have been napping Jackson twice a day as close as I can to 9 and 1 ( depending on his behaviour) and putting him to bed at 6 pm. He still naps for about 1 hr 20 min at a time. I am feeling so much better too after having solid sleeps for about a month now! Although his sleeping is much improved, he is still a fairly fussy infant. I am hoping he grows out of this or it may improve with continued improvement in his sleep. Do you feel that some babies are just early risers at 5 am or do you think I should be adjusting his bedtime still? I know the sleep consultant felt he needed a later bedtime but I am thinking the opposite.

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