Gina Ford’s Contented Little Baby Book became a runaway bestseller when it was first published in 1999. Her advice and methods have been a godsend to tired, stressed parents throughout the world and have helped a generation of children go to bed on time and sleep calmly through the night.
www.contentedbaby.com
Solving your childcare problems starts here.
Organised chronologically for easy reference and with detailed case studies, Gina Ford shares her practical, easy and realistic solutions to the most common toddler challenges.
It is Gina’s belief that sleeping and feeding are intrinsically linked and that all too often babies and toddlers are subjected to unnecessary sleep training methods. Whether your baby or toddler is a fussy feeder, refuses to settle at bedtime or is waking up several times a night, the holistic and gentle approach in this book will ensure that your child’s feeding and sleeping needs are fully met, and that you resolve the root cause of the problem for good.
When you become parents to a newborn baby, you are entering a wonderfully exciting world, but the first few months are often quite daunting. Parents may feel unprepared for the overwhelming change to their lives that a new baby can bring. It will be an enriching experience, but initially you may feel anxious about caring for the tiny new baby who is entirely dependent on you.
Over the years I have worked with many thousands of parents, and helped to find solutions to the challenges they are having with their babies and their toddlers. My first book, The Contented Little Baby Book (published in 1999), was based on my experiences of working with over 300 babies and their families, and since then I have communicated with thousands of parents through my consultancy work and the Contented Baby website, www.contentedbaby.com, which I set up to help parents who felt isolated as they navigated their way through those early months. Through this direct contact, I have become familiar with the most common problems new parents experience. I know how tired and anxious mums and dads can become, desperately seeking immediate solutions to their problems – and they don’t want to search hard for the answers. With that in mind, I decided to write a problem-solving guide, to provide parents with the answers to the questions they most frequently seek. This book addresses the most common problems I come across for parents who need straightforward easy-to-access solutions.
I have divided the chapters up by age in order to focus on the range of issues that can arise at different stages of your baby’s development. Each chapter will begin with a brief explanation of what parents might expect at that age, highlighting some of the areas where concerns can arise. I will then outline and explore some of the most common problems I encounter in my consultations – giving a brief explanation of the problem as you may experience it and then providing the different solutions that can be used to address it.
Within each chapter problems are grouped under ‘feeding’, ‘sleeping’ and ‘general’ problems. What I have found, however, is that all too often a parent comes to me with a sleeping problem that is actually a feeding problem – diet can have a huge impact on sleep – or will come to me with a feeding problem that is caused by overtiredness, which makes feeding difficult. This isn’t just true for babies; with older children too, eating the wrong type of food can lead to behavioural problems. It’s surprising how rarely the overlap between these issues is acknowledged, with so much of the advice offered today being focused on one specific area rather than looking at the bigger picture. I would therefore encourage you to read both sections as what you think is a feeding problem may in fact be caused by something to do with your baby’s sleep.
When parents come to me for consultations, I always aim to get as broad a picture as possible of their baby’s routine, sleep and feeding patterns so that I can see where the links in the chain may be weak or broken, and work out which issues need addressing. I have drawn on all the latest research in the field of childcare, in order to ensure that my conclusions take account of the most recent theories and developments.
You will discover that some of the same problems crop up more than once in the book as you progress from month to month. This is because, as your baby grows and develops, the reasons he may be feeding fussily or waking several times in the night will change so I have tried to take account of what is happening at his age.
Whether you have a specific problem that you are hoping to solve, or just wish to learn more generally about the issues that can arise at different stages of your baby’s development, I hope that you will find much of interest in the pages ahead. I firmly believe that many of the challenges parents face are best addressed in a holistic way, and that this will help ensure that you have a happy and contented baby or toddler.
Gina
I remember my first babysitting assignment with a six-month-old baby. I arrived at the house around 6.45pm and the baby had just been put to bed. I heard a loud wailing from the nursery upstairs, but was assured by the mother that little Joseph would soon settle within 10 minutes. True to his mother’s word within eight minutes Joseph was fast asleep and remained so until the parents arrived home around 11pm.
When I first started caring for babies nearly 40 years ago, strict four-hourly feeding routines with a bedtime around 6.30/7pm was the norm/fashion and this was the approach that was adopted by the majority of parents. Never in a million years did any of those parents I worked for ever think that what they were doing was uncaring. They believed that being a good parent wasn’t just about loving their baby, but ensuring that their baby was well fed and slept soundly, so that long-term sleeping and feeding problems were avoided.
Fast forward 10 years and attitudes to parenting changed, as approaches like baby-led and attachment parenting became the norm/fashion. Out went the strict four-hourly routines, regular feeds and early bedtimes and in came babies feeding every two hours around the clock, watching the 10 o’clock news and sleeping with their parents. Over the next 10 years I worked as a maternity nurse with many different families, some still following the strict four-hourly feeding routines and many more following the more relaxed baby-led approach. Working with so many different families gave me an incredible insight into the different strategies on child rearing. I could see benefits and pitfalls in both approaches and my instinct told me that there had to be a middle ground: an approach somewhere in between the strict old-fashioned four-hourly feeding routines where a baby would not be fed before the scheduled time, regardless of whether they were hungry or not, to the other extreme where the least whimper from a baby, irrespective of what they really needed, prompted a reaction of feeding them.
As the popularity of baby-led parenting increased, so did the use of the famous ‘controlled crying’ method of sleep training. After months and months of feeding two hourly around the clock and babies rarely sleeping more than a two-hour stretch at a time, a huge number of sleep deprived parents would resort to sleep training their baby using the controlled crying method. I was convinced that there must be another way of getting babies to sleep through the night, without having to endure the crying that is inevitable with controlled crying.
This belief led me to taking copious notes for all the babies that I worked with. I charted their sleeping and feeding patterns, some following the baby-led approach and others the strict four-hourly routine approach. Little by little I adapted things from these two parenting methods, combining what I believed to be the best from each and eliminating what I believed to be the negatives. What evolved over those years is what is now known as the Contented Little Baby (CLB) routines. Unlike the four-hourly routines, the nine different routines that I devised for the first year of a baby’s life could be adapted to meet the needs of a baby so that they never had to cry to be fed or because they were tired and needed to be put down. The CLB routines are based upon a baby’s natural feeding and sleeping rhythms – you feed your baby and put him to sleep at certain times, thereby ensuring that his feeding and sleep are in sync with each other so that he is never too tired to feed and always takes a full feed so that he does not wake up from a nap early because he is hungry. Most importantly, the routines can be adapted to suit the individual needs of each baby; from extensive experience, I know that all babies are different.
In the time since this book was published, I have communicated with thousands of parents as a result of my consultancy work and through the Contented Baby website, www.contentedbaby.com. This regular and direct contact has enabled me to obtain useful feedback from parents on the CLB philosophy. The CLB routines and my core philosophy remain the same, but my advice has been expanded in response to this valuable feedback, and adapted to today’s circumstances.
Many years have passed since I first typed the four words, ‘Why follow a routine?’ Little did I know then the controversy those four simple words would create. But here I am, years later, explaining again why I think routine is important. I must stress that my views have not changed one little bit from when I wrote my first book. I personally believe that the majority of babies thrive and are happier in a routine. But I certainly realise and respect that following a routine is not a choice for all parents. The CLB routines will most certainly benefit both you and your baby and they are followed successfully by hundreds of thousands of parents around the world. But follow your own instinct as a parent as to what works best for you and your baby; the advice in this book is for all parents, regardless of whether they follow a routine or not.
Not at all – the advice in this book is for all parents, regardless of whether they follow a routine or not. There are, however, certain aspects of my philosophy and the way I structure the timings of a baby’s day, particularly with regard to sleep, that it would be beneficial to understand so that you can appreciate the logic behind the solutions to the problems or so that when I use terms such as ‘morning nap’ or ‘lunchtime nap’ you will understand what I mean.
In The New Contented Little Baby Book my advice on sleeping is based on a day which runs from 7am to 7pm. The routine within that day is made up of blocks of sleep and awake time based around the baby’s feeding and sleeping needs. By ensuring in the early days that a baby is awake no later than 7am, the timing of this day will allow you to fit in enough feeds, along with short blocks of awake and asleep time, before his 7pm bedtime so that a natural pattern of night-time feeding will also emerge. It will mean that a young baby is only waking and feeding twice in the night between 7pm and 7am. As the baby is always well fed and settled by 7pm, it means that he will sleep his first block of sleep in the night soundly for three to four hours. When he does wake he is ready to take a full feed and then settle back to sleep for his second block of sleep in the night, before waking in the middle of the night for another feed and then settling back to sleep for his third block of sleep.
As the baby grows the second block of sleep will become longer and longer until he is sleeping one shorter block of sleep from 7pm to 10/11pm and one longer block of sleep from a late feed around 10/11pm to nearer 7am in the morning.
By six to seven months most babies who are fully weaned will be ready to drop the late feed and then they will sleep one long block of sleep of 11 to 12 hours, from around 7pm to 6/7am.
Even if you have not been following my CLB routines and starting your day at 7am, the advice in this book can still be adapted and used to help resolve any problems that you may be having. While the individual sleeping and feeding needs of babies do vary from baby to baby, the table opposite will give you an approximate guide as to how much sleep your baby needs during his first year, broken up into night-time sleep and daytime sleep. I hope it will become a useful reference as your baby grows.
I should also stress that, depending on your family’s schedule, a 7am start might not be the most appropriate for you. I know many parents who adapt the timings of their day (and my routines) to suit an 8am to 8pm or 6am to 6pm day, according to their circumstances, so I hope you will do the same if this applies to you.
Understanding your baby’s sleep and how much he needs is one of your most valuable tools in helping you to resolve problems, which is why the whole of the following chapter is devoted to sleep. I’d encourage you to read that chapter before you embark on any kind of problem-solving as I believe it will really help you to understand where things might be going wrong.
Careful planning is the key to resolving problems as quickly as possible. While the advice and case studies in this book are here to help you, they alone will not resolve a problem if you do not also have a clearly written down plan of how you are going to approach it. When you are faced with trying to resolve problems a lack of sleep can blur one day into another and sometimes it is very difficult to remember what the main issues or action points are. By writing down a plan that both you and your partner are agreed upon, you will be much more likely to succeed in resolving it than if you try to deal with it as it is happening.
Timing is also critical. I usually advise parents to try, if possible, to start any form of troubleshooting on a Friday and even better if it can be done on a bank holiday weekend, where you have an extra day to get the plan going. I am not suggesting that your problems will be totally resolved in a weekend, but having three clear days to get your troubleshooting plan in operation, will certainly give you the best chance of a long-term resolution to the problem. Similarly, at weekends there will more likely be two of you at home, or the opportunity to call on another carer, which can provide extra help and support.
Below is a list of helpful tips you can use to prepare your action plan:
Write down what you think is the main problem.
List any additional issues that you think are connected to the problem, such as a partner working very long hours and not being around to help.
Keep a detailed feeding, sleeping and behaviour diary for at least a week before commencing the troubleshooting.
Discuss with your partner, child carer or nursery any points that they think are relevant to the problem.
Once you have made a list of all the relevant points, discuss a plan of action with your partner and how you are going to approach it. Write down your plan of action. It’s very easy to keep deviating when you’re sleep deprived, but the key to resolving problems is to be consistent and writing a plan down will help you stick to it as you can easily refer back to it.
If your problem-solving involves any form of sleep training (see here) agree in advance whether one of you or both of you are going to deal with the night wakings.
Agree a date that you are going to start the troubleshooting and ensure that you keep the first three days clear of any special family occasions, visitors and lengthy outings.
With most problems I’m trying to solve, once you get through the first few days you’re well on your way. Problem-solving can of course be hard, but try to remind yourself that the reason you’re doing this is to build a firm foundation. Any energy you put into problem-solving now will be so useful further down the line and prevent something becoming a long-term or bigger problem.
Sleep is probably one of the most misunderstood and confusing aspects of parenthood. The misconception is that for the first few weeks all a baby will do is feed and sleep. While many do, some newborns can be tense, fretful and difficult to settle and this can be very worrying for new parents. Please take heart – sleep problems in the early days need not be a reflection of your baby’s future sleep habits. However, in order to understand the background to many of the problems in this book and how to solve them, I feel it is important to have an understanding of a baby’s sleep patterns and how much sleep they need.
While the amount of sleep that individual babies need does vary and constantly changes as they grow, having a better understanding of sleep means you will be much more able to determine whether your baby or toddler has, or is possibly developing, a long-term sleep problem.
Above all, before attempting any form of routine or sleep training it is very important that you have a basic understanding of the different stages of sleep that babies and young children experience. Like adults, babies and children drift in and out of different stages of sleep and parents who do not fully understand these different phases often disturb what is a natural progression of the different sleep cycles.
When a baby stirs during a light stage of sleep, he will, if allowed and not needing a feed, usually return to a deeper stage of sleep. Parents who assume that these stirrings are caused by hunger and rush to the baby too quickly to try and get him back to sleep, often create long-term sleep association problems without realising what they are doing. Filmed research shows that all babies come into a light sleep several times a night, some even waking up fully for short spells. When the wakings are not due to genuine hunger, the research shows that the babies who have learned to self-settle will get themselves back to sleep fairly quickly. Babies who have been rocked, patted or fed to get them to sleep are unable to settle themselves back to sleep without the attentions that they associate with going to sleep.
Once the wrong sleep associations are created it will be very difficult for a baby to sleep a longer stretch. A baby who is always rocked, fed or given a dummy to get to sleep will be much more likely to continue to wake several times a night, long after the age when he needs a feed to get him through the night. Because he will naturally come into a light sleep several times a night, he will more than likely need the same comfort to get him back to sleep at each cycle.
Sleep is divided into Rapid Eye Movement (REM) sleep, usually referred to as light sleep, and non-REM sleep, usually referred to as deep sleep. A newborn baby goes straight into REM sleep when he first goes to sleep. During this light sleep his breathing becomes irregular, his body may twitch or jerk, his eyelids will flicker and his eyes appear to roll. He may even smile or frown during this cycle. This sleep is often described as active sleep because a baby uses more oxygen and energy than during non-REM sleep. A baby who has gone full term will spend 50 per cent of his sleep cycle in REM sleep. A premature baby will spend 80 per cent in REM. The rest of the sleep cycle is spent in non-REM sleep.
During non-REM sleep the baby’s breathing will be slow and regular. There are no eye movements and only the occasional twitch or jerk of the body. This calm sleep cycle is often described as quiet sleep. It allows the baby’s mind and body to recharge, enabling him to cope with his next awake period. Research also shows us that this deep sleep is essential for the healthy development of a baby’s mental and physical growth.
Dr Richard Ferber is widely recognised as America’s leading authority in the field of children’s sleep problems. His book Solve Your Child’s Sleep Problems explains every aspect of children’s sleep in great detail, as well as how problems evolve and how parents can resolve them. Dr Ferber says that non-REM sleep is well developed at birth but has not evolved into the four distinct stages experienced by older children and adults. It is not until the second month that a sequence of non-REM sleep stages begins to develop. When a baby of three months is ready to sleep, he first enters Stage One of non-REM – a drowsy sleep – then quickly passes into Stage Two – a light sleep – before reaching Stages Three and Four – very deep sleep. A whole cycle lasts around 40 minutes in babies and for toddlers it is around 60 minutes.
I have observed that it is between the ages of eight and 12 weeks that many parents begin to experience problems with their baby’s daytime sleep, as the different stages of non-REM sleep begin to develop. These more distinct stages of light and deep sleep can sometimes result in a baby waking up 30–40 minutes into his middle-of-the-day nap and having difficulty getting back to sleep, although I have found that is most common in babies who are being assisted to sleep and have not learned how to self-settle.
If your baby is used to self-settling and starts to wake up 30–40 minutes into his lunchtime nap, provided you know he is well fed, then I would recommend that you allow him a short period of fussing to see if he will settle himself back to sleep. Usually I find that babies who are capable of self-settling will go back to sleep within 10–20 minutes. However, a baby who is used to being assisted to sleep is unlikely to return to sleep without your help and even babies who are self-settling at all of their other sleep times, will sometimes have difficulty self-settling at their lunchtime nap. The following tips can help get your baby through his first sleep cycle at the lunchtime nap.
Offer your baby a top-up feed just prior to his lunchtime nap.
Five minutes before your baby comes into his light sleep, stay close by his bed so that when he does come into his light sleep you can quickly shush him and stop his arms from thrashing around, which in turn stops him waking up fully.
If he wakes fully and is getting upset, pick him up and offer him a feed to see if you can get him sleepy enough to settle him back into his bed again.
In the short term the important aim at this point is to get your baby back to sleep whichever way you can, so that he wakes up refreshed and happy to cope with social activities in the afternoon. In the long term, however, it is best if you help teach your baby to self-settle, so that he eventually learns to self-settle when he comes into his light sleep cycles during his lunchtime nap. If at this age you do not teach your baby to self-settle, you could find that he starts to wake in the evening 30–40 minutes after he has gone to sleep, and then increasingly start to wake up more often during the night when he comes into his light sleep cycle. Through my consultancy I often have to deal with young babies who are not capable of sleeping longer than one sleep cycle and need to be assisted back to sleep several times during the night.
If you find that despite all of your efforts your baby does not settle back to sleep at his lunchtime nap, you will then have to offer him two shorter naps in the afternoon: the first one probably being 1–1½ hours from the time he woke up from his lunchtime nap and the second usually another 1–1½ hours after that. The length of the naps will depend on how old your baby is, but a general guideline is to split what is left of his daily sleep allowance between the two shorter naps.
Allowing too much sleep during the day can result in middle-of-the-night wakings or in difficulty settling your baby in the evening. But allowing too little sleep can often result in worse problems. Many parents make the mistake of allowing their baby or toddler little or no sleep during the day in the belief that he will sleep better at night. In my experience this rarely works, as the baby or toddler usually becomes so overtired and irritable that he is difficult to settle in the evening and is much more likely to wake in the night. Research confirms what I have always believed. Poor quality daytime sleep can affect not only the baby’s mental development but also his ability to sleep well at night. Dr Marc Weissbluth, a leading researcher, paediatrician and founder of the Sleep Disorders Center, Children’s Memorial Hospital, Chicago, and the Northwestern Children’s Practice, has conducted extensive research into the nap patterns of more than 200 children. In his book Healthy Sleep Habits, Happy Child he says that: ‘Napping is one of the health habits that sets the stage for good overall sleep.’ He explains that a nap offers the baby or child a break from stimuli and allows it to recharge for further activity. Several other experts are in agreement that naps are essential to a baby’s brain development and to helping establish long-term healthy sleep patterns. John Herman, PhD, infant sleep expert and associate professor of psychology and psychiatry at the University of Texas, says: ‘If activities are being scheduled to the detriment of sleep, it’s a mistake. Parents should remember that everything else in a baby’s life should come after sleeping and eating.’ Charles Schaefer, PhD, an American professor of psychology, supports this research and says: ‘Naps structure the day, shape both the baby’s and the mother’s moods and offer the only opportunity for Mom to relax or accomplish a few tasks.’ There is further evidence to support my view of the importance of daytime sleep being established at the right time. The best time for the longest nap of the day is between 12 noon and 2pm as this coincides with a baby’s natural dip in alertness. A nap at this time will be deeper and more refreshing than a nap that starts later in the day.
Although babies and toddlers do vary in the amount of sleep they require, it is important that you have a clear understanding of how much sleep they need. The following summary of daytime sleep is a guide to how much sleep your baby or toddler needs and the best times for sleep to happen.
During the first week or two most newborns will only manage to stay awake for an hour or so at a time and most of this time is taken up with feeding and changing. Between the second to fourth week they will usually be managing to stay awake properly for one to one and a half hours, although some very wakeful babies may manage to stay awake for up to two hours. The important thing to remember during the very early days is never to let your baby stay awake longer than two hours. If a baby stays awake longer than two hours he will often become overtired and fight sleep when you try to put him down for a nap. Overtiredness is one of the main causes of very young babies not settling well at nap times, and care should be taken that this does not happen.
Generally speaking, a baby under one month of age is usually ready for a nap one and a half hours after the time he wakes in the morning; some sleepy babies may only manage to stay awake for up to one hour. By the time babies reach two months, providing they’re sleeping well at night, it is likely that they will manage to stay awake nearer to two hours before needing their morning nap. A typical pattern may be that when they first wake in the morning, they will stay awake for a full two hours, then after they have their first nap of the day they may only manage to stay awake for one and a half hours. Again the important thing is to watch for your baby’s cues (see box overleaf) as to when he is sleepy and ensure that he is well fed and settled in his bed before he becomes overtired.
By the time they reach six months, the majority of babies can stay awake for between two and two and a half hours provided they’re sleeping well in the night. If you are starting your day at 7am, babies should be woken from their morning nap no later than 10am if you want them to sleep for a longer time at midday, even if this means they have a short morning nap of only 20 minutes.
Between nine and 12 months most babies will cut right back on their morning nap, cutting it out altogether somewhere between 12 and 15 months. If you notice your baby starting to cut back on his lunchtime nap or waking earlier in the morning, this is a sign that he may need to cut the morning nap out. Some babies, if they’re not sleeping well at night or at their lunchtime nap, may need to drop the morning nap sooner, sometime between nine and 12 months.
Signs your baby is ready to sleep
Below are the most obvious signs that your baby is getting tired and ready to sleep. Although he may not be quite ready to sleep the minute you notice any of the following signs, you should take your baby to his bed and have some quiet time: allow 10–20 minutes of quiet time with babies under six months and 5–10 minutes with older babies. With quiet time it is best to hold your baby in the crook of your arm as opposed to over your shoulder or across your chest, that way he will not suddenly miss the pressure of your body when laid in his bed. The minute his eyes start to get heavy and you notice that they are more closed than open, you should settle him in his bed, before he gets into a deep sleep. It is important that your baby is sleepy but aware that he is going into his bed. It is also important that you allow him a short period of fussing. If you find that the fussing starts to escalate into crying you should try shushing and patting him in his bed rather than immediately picking him up. With very young babies who do not settle within 10–20 minutes, it is possible that hunger is the cause and they should be offered a feed and then resettled using the same procedure as above.
He starts to yawn – not just once but two or three times
His eyes start to open and close quite rapidly
He pulls his head to one side as if trying to root for a feed
His body becomes tense; some babies also arch their back
He starts grizzling or crying very suddenly
Older babies may pull at their ears or start to suck their fingers.
A baby under one month is usually ready for this nap one to one and a half hours after the time he wakes from his morning nap, but by the time he reaches two months he can usually make it to two hours. Ideally, this should be the longest nap of the day, as research shows that a nap between 12 noon and 2pm is deeper and more refreshing than a later nap, because it coincides with the baby’s natural dip in alertness.
Depending on how well the baby has slept at his morning nap, this nap usually lasts between two and two and a half hours reducing to around two hours by six months. At around one year this may be cut back to one and a half hours if the baby is still having a full 45-minute nap in the morning, although it may lengthen again to two hours if the morning nap is cut right back or dropped altogether. At one year the length of the lunchtime nap is determined by how well the baby is sleeping at night. Some babies who are sleeping 12 hours at night will continue to need two hours’ sleep at lunchtime, while some babies, if they are waking earlier in the morning, will need to have their lunchtime nap cut back. The majority of babies will continue to need a nap in the middle of the day until they are at least two years of age with the length of the nap again depending on how well they’re sleeping at night. Babies who are starting to wake earlier or starting to wake in the night may need to have their lunchtime nap cut down or cut out altogether. This can happen anywhere between 18 months and three years of age, depending on the child’s individual needs.
If a baby sleeps well at the two earlier naps of the day, this should be the shortest of the three naps. A baby under eight weeks usually needs between 30 minutes and one hour. By the time they reach 12 weeks the majority of babies who have slept well at lunchtime will only need a very short nap of 10–20 minutes, in order to revive them enough for the bath and bedtime routine. This nap is usually dropped by the age of four months provided they’re sleeping well at their lunchtime nap. If a baby is having less than two hours at lunchtime, they may continue to need 10–15 minutes in the late afternoon until nearer nine months of age. Allowing a baby to have too much sleep later in the day is often the reason a baby does not settle well at his bedtime. The total amount of daily sleep your baby or toddler has between 7am and 7pm (depending on when you start your day) will play a big part in how well he sleeps at night. The timing of the sleep is also important if overtiredness is to be avoided. Listed below is an approximate guide to the number of hours of daily nap time a baby or toddler needs.
Birth to four weeks – 5 hours
Four to eight weeks – 4 to 4½ hours
Eight to 12 weeks – 3½ hours
Three to six months – 3 hours
Six to 12 months – 2½ to 3 hours
12 to 15 months – 2½ hours
15 to 18 months – 2 to 2½ hours
18 to 24 months – 2 hours
Two to two and a half years – 1 to 2 hours
Two and a half to three years – 0 to 1 hour
Through all my experience of working with children I have come to the conclusion that the key to ensuring good sleeping habits is teaching your baby or child to go to sleep in his cot/bed unassisted. Establishing the right sleep associations from an early age is vital if you wish to avoid long-term sleep problems.
If you constantly cuddle, rock, feed or use a dummy to get your baby to sleep, it is what he will come to associate with falling asleep. This does not often create a problem during the first few weeks, but once the baby develops and starts to come into a light sleep every 30–40 minutes, a real problem can evolve. In my experience babies who depend on their parents to help them get to sleep will, at around eight to 12 weeks, start to wake up increasingly in the night. Babies who were often feeding only once in the night end up feeding every couple of hours; others will not settle unless cuddled or rocked.
If your baby is under eight weeks, this problem can be avoided by ensuring that you allow enough time to settle your baby at sleep times. Make a note of how long your baby can stay awake before he falls asleep then make sure that you allow a 10- or 15-minute wind down period before he goes to sleep. If he has fed earlier and is unsettled but you are sure he is not hungry or windy, give him a cuddle or the dummy, but make sure that he is settled in his cot before he falls asleep and without the dummy. If he has just had a feed and is falling asleep on the breast or bottle, try to rouse him slightly before you put him into the cot so that he is aware that he is going to bed. Provided he has been well fed and winded and is ready to sleep, he should drift off to sleep within five to 10 minutes, although I have had a few babies who would fuss and fret for up to 20 minutes before settling off to sleep.
If your baby is under eight weeks and not settling well despite looking sleepy, it is important that you look closely at his feeding. In my experience the cause is usually one of two things: the baby is still hungry or the baby was too sleepy during the feed and has not fed properly (see box below). With an older baby or toddler who doesn’t know how to go to sleep unassisted, eliminating the wrong sleep associations will be more difficult and some form of sleep training (see Chapter 10) will probably be needed if persistent night-time wakings are to be resolved and a healthy sleeping pattern established. Establishing healthy sleeping habits also depends on several other factors. Getting the feeding right and ensuring that your baby or toddler’s physical, mental and emotional needs are being met also have a huge influence on how well he sleeps.
Is your baby feeding or sleeping on the breast?
If you allow your baby to feed with his eyes closed or half asleep, two things can happen: firstly, he won’t feed properly and will still be hungry or show signs of hunger again very soon after his feed. Secondly, the feed time will actually amount to a little catnap, which will have a knock-on effect on his sleep later in the day. By catnapping, he will have added to his sleep quota for the day and therefore may not go down properly for his next sleep. This prevents you trying to establish proper nap times and can therefore cause more longer-term problems.
The majority of experts agree that a good bedtime routine is important for young babies and children. However, there is much disagreement over the age at which parents should start a bedtime routine and what it should consist of. Somewhere between the age of six weeks and three months seems to be the time that most experts think you can start to establish regular times for a bath, feed and then settling the baby in his bed.
My own view is that the sooner a bedtime routine is established, the less likely the parents are to encounter problems trying to settle their baby. When I worked as a maternity nurse I established a routine in the very early days, usually around the fifth day, when the mother’s milk came in. I believe that this is one of the reasons I rarely had to deal with a crying baby in the evening. Of course there are times in the early days when a young baby will not immediately fall asleep, but if you are consistent in how you try to settle him, a pattern should emerge where he settles quickly and easily, between 6.30 and 7pm. This will have a knock-on effect on what happens later and in the middle of the night. A baby who feeds and settles well in the early evening and sleeps until his next feed is due is much more likely to feed well at the last feed of the night, which should come at around 10 or 11pm.
This is particularly true of breastfed babies, as the time the baby sleeps in the evening allows the mother to have a meal and a good rest, which will help ensure that she has time to produce enough milk for a good feed last thing at night. A baby who has a good last feed is much more likely only to wake up once in the night and then settle quickly, because again the mother will have had sufficient rest to produce enough milk for a full feed.
Regardless of whether he is bottle-fed or breastfed, if a baby gets into the habit of catnapping in the early evening, he will more than likely get into the habit of feeding little and often. When the parents attempt to offer him a late feed before they go to bed, it is very unlikely that he will take a full feed, particularly if he has fed within the last couple of hours. He will therefore be much more likely to wake up around 1am looking for a feed, then again at 5am. A pattern of two feeds a night is very quickly established, and for a breastfeeding mother this can have dire consequences, as tiredness sets in and the milk supply is greatly reduced. If you wish to avoid a pattern of unsettled evenings and excessive waking in the middle of the night, I would strongly advise that you establish a routine as soon as possible.
I am aware that many experts advise that it is not necessary to bathe your baby every day and that a top and tail will suffice in the early days. I believe that babies are no different from us adults and that a warm bath and a gentle massage is a wonderful way of unwinding and relaxing in the evening. Research also shows that babies who are bathed and massaged in the evening tend to sleep better than those that aren’t.
The first four weeks of your baby’s life can feel overwhelming, and new parents are often anxious and uncertain about how best to look after their newborn. The focus at this stage is really on the basics: sleeping, feeding and changing your baby’s nappy. It often feels as if this takes up all your day at first and there is little time left for anything else. Although your baby’s needs may initially seem all-consuming, you will gradually become more confident and adept.
In the very early days, you may still be recovering from the birth, particularly if you had a difficult labour or a Caesarean section, and you should not underestimate what an impact this can have. You may experience the ‘baby blues’ at this time, or you may feel totally elated. I always recommend trying to enjoy a ‘baby moon’ in the first few weeks where you spend time getting to know your baby with your partner, and try to limit visitors which can help you to become more confident about caring for your baby as well as giving you time to recover physically.
Newborn babies need to feed a lot as their tummies are tiny; most will feed anything from eight to 12 times a day and some even more. And in the early days, your baby may need his nappy changing as many as 12 times a day, but this will gradually reduce.
The other concern for parents at this stage is their baby’s sleeping pattern and if you don’t have any kind of routine for your baby, you may find that you are being woken up throughout the night not just in the very early days, but throughout the first few months. Establishing a sleep pattern will help to ensure that everyone in the family gets the sleep that they need.
Young babies can go through an unsettled period around the age of three to six weeks when they go through a growth spurt and may cry more than usual. If your baby is crying a lot you will want to make sure that you have eliminated the possible causes, which may be hunger, tiredness, overtiredness, wind or colic. Sometimes babies are just bored, as they do need some stimulation when they are awake.
The first month is a time of rapid development for your baby, as he begins to respond more to you and to his environment. A newborn baby has quite limited vision and his eyes are light sensitive. He has little head control, and you will need to support his head and neck when you pick him up. As he grows and develops, his vision and hearing improve so that he can see and hear you more clearly.