by Nicholas B. Levy, Pediatrician
Four-month-old infants are old enough and big enough to sleep through the night. They are capable of sleeping for a full 10 hours at a stretch by this age and will nap two, or even three, times a day.
Some children do seem to need less sleep than others, but a minimum of nine hours at night should be encouraged.
Good, uninterrupted sleep will ensure rested parents who have a lot more energy for their children and more time for each other.
Families that choose to sleep with their children in a “family bed” should now begin to ensure that their baby knows how to fall asleep without them. Baby can fall asleep in the family bed, but shouldn’t have to rely on Mommy or Daddy’s presence.
It should go without saying that the family bed has to be safe for the baby. Complete edge barriers, a firm mattress and no comforter until parents are in bed, are just some of the safety requirements.
Parents may want to consider putting baby down in a crib in the room and then taking baby to bed with them when they are ready to retire for the night. Couples should definitely spend some time thinking about whether they will both want their 3- or 4-year-old to sleep in bed with them.
Set up the sleeping arrangements now in a way that will work in the long term and make sure that both parents agree on these issues.
By 4 months of age some babies have already learned how to fall asleep alone, while others are being “parented” to sleep, i.e. a parent is present with them as they drift off. Infants who rely on the presence of a parent to fall asleep will almost certainly wake their parents during the night. When these babies wake up during the night, as they all will, parents need to re-create the situation that comforts their baby and allows him or her to fall back to sleep.
Four-month-olds will sometimes sleep through the night even when they have been rocked or nursed to sleep, but as they reach the next phase of emotional development (separation and development of self) they will start to demand the presence of a parent in the middle of the night. This will usually start to surface by 6 to 9 months of age as separation anxiety becomes more pronounced.
It is important to establish a nighttime routine, but parents should complement this with daytime separation as well. Avoid constantly holding the baby and encourage experience with people other than the immediate family.
A good way to create a nighttime routine is to feed baby dinner, and then give a bath. The bath is not only relaxing, but also separates eating and sleeping so that food does not become part of the way in which baby falls asleep.
After the bath, babies are nice and warm and snuggly and a few minutes of rocking in a chair or reading or singing to them is soothing. After this brief session, say goodnight and put baby down in a crib in his or her own room or into the family bed. Briefly settle baby and then leave the room.
If baby cries, look at your watch and wait a minute. This is sometimes called the longest minute in the world! At the end of the minute go into the room with a very sleepy attitude, speak in a whisper and don’t turn on the lights.
Tell baby that everything is OK, but that it’s time to sleep. You can gently pat them or rock the crib, but don’t actually pick baby up. Then say goodnight and leave the room again.
If the crying starts up again or if your brief interaction didn’t settle baby, then wait for five minutes before you go in again. It really is important to use a clock to measure the five minutes. After five minutes go back into the room, but this time don’t touch baby at all, just use a soothing voice.
Tell them once again that everything is OK, but that it’s still time to sleep and then leave the room. Take about 20 to 30 seconds to talk soothingly from the door of the room. If baby continues to cry, wait for a full 10 minutes before going back in.
Once again, just use your voice to reassure baby that you are there. Some babies seem to cry more loudly or more angrily when they hear Mom or Dad’s voice and are still not picked up. Don’t be discouraged by this.
The message you are giving is that you are ignoring baby, but that you have not abandoned or deserted him or her. In other words you are using this technique to teach the baby and not to punish.
In general, infants at this age will fall asleep during the five- or 10-minute crying period. If your baby persists, however, you have to be willing to outlast the crying. Wait for 15 minutes and again use your voice before waiting a full 20 minutes.
If needed go on to a 25-minute period, and then return every 30 minutes to use your voice to reassure baby that all is well with the world and that you are nearby.
If baby has cried for an hour or more and you give in and pick baby up, you are teaching that enough crying will eventually get you to come back in. If you make the mistake of responding to this they will be sure to do it for you again the next time!
If and when baby wakes up during the night, don’t respond for the first minute. If the crying persists, go and check to make sure that nothing is wrong and then launch into the five-minute crying period. Follow this with a 10-minute period and so on.
In most cases, infants will continue to cry at bed time or wake up during the night for as long as a week. It often only takes a night or two, and then the whole family can look forward to solid, uninterrupted sleep for years to come.
This Scripps Health and Wellness information was provided by Nicholas B. Levy, pediatrician at Scripps Coastal Medical Center Encinitas.