Introduction

https://vimeo.com/552902824/81b1b25a41

This module is all about making the big changes to sleep. It’s also really long! So you may want to skip through some of it, depending on what is relevant. Or you may want to grab your workbook and work out the steps that you need to take to reach your goals with regards to sleep, and then watch the sections that you need to.

Hopefully, by the time you’ve got to this point, you’ve already seen an improvement in sleep. Perhaps you’re ready to pause at this stage and wait. You’re ok with the way sleep is happening right now. Or perhaps you need to make a few more changes. If you still need to make changes, then before you jump in with both feet I want you to take a pause and make sure that you’ve done the following:

  • You’ve looked at the Simple Sleep Solutions, which means that you’ve improved your baby’s sleep hygiene. You’re giving your child plenty of exercise and sensory experiences during the day. You’ve ruled out any underlying medical issues that might be affecting sleep, you’ve looked at diet and nutrition.
  • You’ve done some Sleep Shaping, by working out your child’s averages for sleep, and optimized naps and bedtime.

If you’re feeling like life is particularly chaotic, and you’re struggling to work out how you’re going to find the energy to make changes to sleep, then I’d encourage you to take a look at the module: Simplify Your Life. I’m sure it seems really weird to have a module like this in a sleep course but it’s because there are some ideas in the module that will make the whole job of parenting a lot easier. If you are going to embark on making significant changes to sleep, then it’ll probably feel worse before it feels better. You’re probably doing the easiest thing you can already when it comes to sleep, so any changes are going to feel really hard, as you work through them. Taking the pressure off you in other areas first, will make the sleep changes easier. And finally, before you move forward, I want you to pause and ask the following questions. Are you making changes because:

  • You are worried about what might happen in the future? For example, is your child starting day care in a few months and you think you need to change how sleep happens, now? Or will you be starting night shifts when you go back to work, and you need your baby to be able to fall asleep without breastfeeding to sleep? If that’s that case, then you might want to just wait. It usually takes about 8 weeks for new habits to consolidate, and some babies will adapt to a change within 2-3 weeks. I’ve seen super-adaptable babies go from contact napping with a boob in their mouth to self-settling in the cot within 5 weeks. So perhaps you can wait for a bit longer?
  • You’re feeling pressure from others? Perhaps you’re actually ok with how sleep happens but it’s others who are telling you that your baby shouldn’t be cuddled to sleep, or fed to sleep, or co-sleeping. If it’s working for you, then there is no need to change. There are no bad habits when it comes to sleep, and please, only feel you need to change how sleep happens if it’s no longer working for you.
  • What’s happening right now isn’t sustainable? Then please! Read on. And I hope you find the right solution in this module to make sleep more sustainable for you. If you need some help planning out your steps for making changes, you can book a online clinic slot with me here.

Changing sleep in a way that is gentle and responsive

I’m going to let you in on a little secret… almost all the strategies in this module are present in some incarnation in most sleep training books. They will have different names, perhaps encourage parents to move at different speeds, or perhaps encourage a non-response to a distressed baby. 

So what makes my course different? Well, you could take any of the methods in this module, and enforce it with your baby. If you don’t care about crying, you can just stick it out. But I know that you want to be responsive, so it gets a bit tricky. Under the age of a year (and where some toddlers are concerned too!) children have needs, not wants. These needs must be met. They also have three basic needs when it come to sleep: they need to be tired enough, they need to be calm and they need to feel connected to you. In order to change how your baby falls asleep, you need to make sure all three of those components are in place EVERY SINGLE TIME you use a strategy to change how sleep is happening. 

So let’s look at some options for Calming and Connecting.

Your baby needs to be calm

Your routines are going to be really important for calming your baby in the lead up to bedtime. So, if you have a short nap routine and a longer bedtime routine, these will help your baby settle and be ready for sleep. I’ve mentioned these before in the Simple Sleep Solutions module. If you haven’t introduced any routines yet, now is a good time to start! 

You might also want to think about introducing several new sleep associations. Basically, these are just several different cues that you can use to signal to your baby that it’s time for sleep. Lyndsay Hookway, in her book Let’s Talk About Your New Family’s Sleep (2020), mentions habit stacking – which is pretty much the same thing as sleep associations, and suggests using the five senses, and having at least one association for each of the senses:

Sight – you could take your baby to their room for naps and bedtime;

Sound – you could play white noise (or pink noise for babies over 6 months), sing a lullaby, hum, shush;

Smell – you could wear a muslin next to your skin and then tuck that over the cot mattress, or for an older baby put a comfort object against your skin. You could also try a drop of soothing aromatherapy oil somewhere in the room – just be careful with babies that have very sensitive noses – even the most soothing of scents can be overly stimulating for some babies!

Touch – if they are old enough you could use a taggy blanket or comfort object. You could pat, rub, stroke their skin, perhaps hold their hand;

Taste – the only one that really works for this one is milk!

Your baby needs to feel connected

When you spend time with your child before naps or bedtime, you provide a time for connection and sometimes, re-connection. Some people will talk about babies having a “love tank” that we need to fill up for sleep to happen. Your routines before naps and bedtime can give you a chance to fill this love tank.

Bedtime is often a time of separation for babies – once they fall asleep they are on their own. If this is the case, then we also need to think of ways to bridge that gap, and leave them some aspect of connection with us. So this may be a muslin tucked over the cot mattress that smells of you, because you’ve had it tucked in next to your skin, or a photo of you next to their cot. Some parents may even choose to record a track of them singing or talking, and play it at a low volume overnight. 

Your baby’s temperament

Why does temperament matter? Well, some babies with a certain temperament find it much harder to adjust to changes. In fact, I’d say that the majority of my clients have babies with temperament traits that lie at one end of the scale. It’s not that these temperament traits are negative in any way, they just make for more difficult sleep!

In your workbook there is a temperament quiz – take a look and score your child according to the best description there. If you find that you are circling mostly the middle categories, making changes with sleep will probably be relatively easy. If you find that you’re circling either zeros or fives… well… you may find making changes are harder. Not impossible, but you may just need to alter your approach.

For example, if your child is very persistent, it’s going to take longer to make changes. If they are not very adaptable, then it might make sense to do one big shift in one go, rather than making lots of little changes, especially if they get really upset with even a small change to sleep. If they are very sensitive, then you may find that they need less sleep associations – too many may actually overstimulate them. I normally don’t do a sensory profile on babies under the age of 12 months, but I do include it in my toddler sleep assessments. If you think that your child is particularly sensitive, then you can look at the workbook in the Simple Sleep Solutions 18 months – 3 years module. And finally, if your child has a very intense reaction to a change in sleep (ie a lot of crying) – how do you feel about persisting with making that change?

If you want to book a clinic appointment to discuss either your temperament quiz or the sensory profile, and how this will affect the changes you need to make to sleep, you can book it here.

Crying

I’ve left the discussion around crying to this module. That’s because nothing I’ve suggested so far SHOULD result in crying. So far, we’ve been working with your baby’s biological sleep drive and supporting them to sleep in the easiest way possible. I’ll be honest and say that as a sleep coach, I prefer approaches that result in zero crying, especially in this age group. With older children, it is important to have boundaries and it’s ok if they get upset, as long as they are supported through the emotion. With babies and younger toddlers, I think it is important to respect their needs, which is why I prefer the path of least resistance. Sometimes, if you can adjust your own expectations of what your baby is capable of, if you can make adjustments to your sleeping arrangements, or your own lifestyle to accommodate the needs of your baby, that is the best option at this stage. 

However, sometimes change is necessary. When change is necessary, and crying happens, I think it’s important to remember that we regulate our child’s emotions. Small babies and young toddlers do not have the emotional or mental capacity to self-soothe (in spite of what some baby books tell us). Our emotional state helps to regulate their emotional state, and contact with us helps to calm then. Therefore, there is a clear hierarchy in that process of soothing. Crying in arms is much better for brain development and emotional regulation than crying in a cot, even with parental support next to the cot (patting, talking, reassuring). But a parent sitting next to the cot, offering reassurance, is still better than leaving a child to cry, unsupported in a room. Some babies may be be able to tolerate the stress of being left to cry alone, but we really don’t understand the long-term consequences of “cry it out” practices. While there isn’t clear evidence of harm emerging from these studies, we know enough about neuroscience and the development of babies’ brains to know that it is probably not the best option for our babies. If you’d like to know more, I’d highly recommend reading either of Margot Sunderland’s books: The Science of Parenting or What Every Parent Needs to Know – both are very easy reading and explain the neuroscience behind attachment, bonding and responsive parenting. For most parents, it’s isn’t the science behind “cry it out” that convinces them, it’s more that it feels instinctively wrong to leave their child to cry alone – and if something feels wrong, it’s always ok to stop, reassess and try something different. If you try one of the strategies in this module and you can’t find a way to progress without crying, please book a free phone call with me to have a chat about how to move forward.

You want your baby to more independent

It can be really difficult when our babies seem to need us intensely. Perhaps we’ve cuddled them through the Fourth Trimester, co-sleeping, using a sling and we’ve got to 6 months when they can move into their own room, but they still seem to need us so much! Independence is not something we can force with our babies. In fact, the evidence suggests that the more we meet that need for connection and closeness, the more secure and independent our children will be in the long run. So there really is no rush from a developmental perspective. 

There are often two big peaks in separation anxiety in children, at around 8-10 months and again around 16-18 months. I’d avoid making any big changes to sleep that involve creating a distance between your child and yourself at these times. There are a few things that you can do to help your child through these periods of separation:

  • Lots of love and cuddles! They need more reassurance at this stage, not less.
  • If you are leaving a room, always let them know that you’re going, rather than sneaking away. They may fuss and cry as you leave, but they’ll learn that you aren’t just going to disappear when they are distracted. This is especially true for child care – it’s always best to let them know you’re leaving. 
  • Playing peekaboo, reading books with flaps, and playing hide and seek when they’re going through the second phase of separation anxiety, all help to reinforce the concept of object permanence – that when something (or someone) disappears, it doesn’t mean that they are gone for ever.

How to use the strategies in this module

What follows are step by step guides to changing sleep in specific situations – if I’ve left one out, please feel free to contact me and I’ll add yours in! You may find that you need to break your goal down into further steps. For example, if you are co-sleeping and you want your child to fall asleep in the cot, do you want to feed to sleep and transfer asleep? In which case you just need to get them used to being in their cot. However, if you want them to fall asleep in their cot, you need to: get them used to being in the cot, stop feeding to sleep AND help them learn to fall asleep in the cot. You then need to decide what order to do things in – I’d always start with the easiest change first and then build on the momentum. 

Remember your child needs to be tired enough (use sleep pressure to your advantage), they need to be calm and they need to feel connected to you. Bedtime is often a good time to make a change as you have the advantage of sleep pressure and the circadian rhythm. Often just making a change at bedtime has an impact on the rest of the night, or on naps. If you just want to make a change around naps, start with the easiest nap of the day (usually the first nap). You can decide to make a change just at bedtime, and the first part of the night, or you can decide to do everything in one go – a lot depends on your goals and how fast you need to go. 

There is a planner in your workbook, but if you are struggling to work out the steps, you may want to book a clinic session with me to work out the finer details of how to move forward.

Finally, consistency is key. If you decide to make a change, it may not happen straight away. Most children do adapt within 3-5 days, more persistent children may take as long as a week. If you decide to make a change, I’d work at it at a pace that feels comfortable for you and your child. Please pick them up for a cuddle at any stage, if you feel they need to be comforted. But try not to let them fall asleep in the way they’ve been used to. Either try again once they’re calm, or cut your losses and do a “dramatic wake up” – you pretend that it’s time to get up again, and go downstairs and wait for them to be really calm. Then, you can either try to get them to sleep in the new way (hoping that the added sleep pressure will help), or get them to sleep in the “old” way. The most important thing is not to move straight from the new way you’re attempting to the old way, without a break. Otherwise, all that does is reinforce that if they persist long enough, they’ll get to fall asleep the way they want to. It’s not that babies are manipulative, but there is some awareness of transitions. So for example, if for three nights you try to cuddle to sleep instead of feeding to sleep but after a few cycles of protest, you just feed to sleep, they haven’t learned that they can fall asleep in a different way, but they have learned that fussing will get them what they want. Nothing changes. If instead, you cuddle, offer a short feed when they get upset, then stop feeding, cuddle to try to help them fall asleep, offer a short feed when they get upset, then cuddle to sleep they learn that they CAN fall asleep without feeding. Change starts to happen.

Changing habits is hard! You’re asking your child to change something that they don’t want to change, and it’s all they’ve ever known. Think of a time you made a conscious decision to change something you do regularly – how hard was it, even when you knew you needed to make a change? Now imagine how much harder that is for a baby. Patience and kindness is needed to make those changes for them. 

What if your baby prefers one parent at bedtime?

https://vimeo.com/552943816/b1f67727d0

This is a really common issue, and can be quite inconvenient at times! If this happens, you have a few options:

  • It might be a case that the preferred parent does bedtime, and the other parent commits to picking up the slack with tidying, laundry and cleaning.
  • You can gradually introduce the non-preferred parent into the bedtime routine, initially at the peripheries, eg sitting a corner of the room for a few nights, then reading a bedtime story with the child between both parents, then gradually doing more of the comforting measures to help the child fall asleep, while the preferred parent still stays there.
  • The preferred parent leaves the house! Often when a baby/toddler realizes that their “favourite” parent is gone, they accept the other parent more readily. 

Stopping co-sleeping

https://vimeo.com/552961355/069987723b

Suggested age: You can move away from co-sleeping at any age, although it’s best to avoid those periods of separation anxiety.

Co-sleeping can be a great option for parents and it often works really well to improve sleep for everyone. Until it doesn’t work any more, of course! There is no specific age when you have to stop co-sleeping. It is definitely not associated with any developmental delays – some evidence shows it actually increases confidence and independence in children.  However, when you’re ready to stop co-sleeping it might be worth considering the steps you need to take for co-sleeping to stop. Rather than address each point here – they are expanded on further below, but the normal progression would involve one or all of the following steps:

  • Room and cot acclimatization 
  • Stopping contact sleeping / creating some distance between you
  • Stopping feeding to sleep/ stop rocking to sleep
  • Your child learning to self-settle in the cot 

Changing sleep for daycare

Suggested age: You can start these changes at any age. It might be useful to start making changes around 5-8 weeks before your child is starting daycare.

This is often a big concern for parents. Perhaps you’re completely happy with feeding to sleep or contact napping, but you know this won’t be possible when you start back to work. 

The first thing I’d suggest is that you talk to your day care. A lot of nurseries will provide some support for babies as they fall asleep – they may cuddle them to sleep, for example. This may be a good time to get a good feel for how responsive they are to babies! If you can find out what they will do to help babies sleep, you only have to work towards that, rather than working at getting your baby to fall asleep independently. Steps that you may want to consider include:

  • Stopping contact napping
  • Cot acclimatization 
  • Introducing a comfort object that reminds your child of you
  • Stopping feeding/rocking to sleep
  • Your child learning to self-settle in the cot
  • A “settling in” period in your child’s day care 

Moving away from contact sleep

https://vimeo.com/552927109/9353ace4fb

Suggested age: You can start these changes at any age, however, I’d be inclined to wait until they are over 3 months unless there are serious concerns about safety, for example, your baby will only sleep on you at night time and you’re worried about falling asleep with a baby lying on you.

I’m going to define contact sleep as a need for your baby to sleep on you, or touching you.

It’s worth thinking about the lead up to naptime or bedtime and spend lots of time in contact with your baby, or providing some containment. So for example, carrying your baby in a sling, lots of cuddles, perhaps even wrapping them up tight like sushi rolls in a blanket (you can incorporate this into some play, and make sure their heads remain free!). 

Then when it comes to sleep you want to start moving them away from you in a step-wise fashion. I’d leave at least a week in between each step. Sometimes the first few nights babies are ok with this new change, and then they have a little “blip” where they want to go back to the way things were, so there might be some fussing. If you give them lots of reassurance when they’re fussy, without going back to what you used to do, they will usually accept the new change after another 2-3 night. So it might be a case of 3-5 nights for them to accept a new change, then 2-3 nights of being fine, then a couple of nights of being fussy and wanting to go back to the way it used to be, then they accept the change, and yu can move on to the next step.

  •  If baby lies on top of you, move them to the crook of your arm so they are lying on their side, rather than tummy down.
  • Then move them to lying on their back, but next to you.
  • Then you can create some distance between you on your bed – if they are over a year, could you use a comfort object and place that between you?
  • Continue to increase the distance as much as practically possible.

Cot and bedroom acclimatization

https://vimeo.com/552948671/dde5316c78

Suggested age: Over six months 

Parents often decide to move their babies out of their room at around six months. There is a period of separation anxiety around 8-10 months, so I’d avoid moving a baby out of your room at that stage, so if you are going to move them, do it between 6 and 8 months, or wait till after 10 months. It’s also worth remembering that the safe sleep guidelines state that baby should sleep in your room for AT LEAST 6 months. If it’s working for you, baby can sleep in a cot in your room for longer – it sometimes makes night feeds less disruptive! If the cot is in your room and you’re moving either from co-sleeping or from a sidecar crib, you can skip this first three steps for now:

  • Start to spend some time every day in your baby’s room. This can be a time of quiet play or perhaps you could feed your baby here, even if baby doesn’t go to bed in this room just yet. Perhaps you can add a step to your nap routine or bedtime routine where you go round the room and say “Goodnight teddy”, “Goodnight lamp”, “Goodnight books” etc. 
  • You may want to put some photos of your family in the bedroom, near the cot. You can even print out a “headshot” of yourself and blue tac it to the wall – around A4 size often works well, because it is more life sized.
  • You could consider sleeping in the baby’s room with them initially – either together in an adult bed (making sure it’s safe), or on a floor bed. A floor bed is also a great transitional step if you are moving from co-sleeping to your baby sleeping in a cot. You can either put an adult mattress on the floor and let your baby sleep there, or you can temporarily move the cot mattress onto the floor and help your baby fall asleep there. Once they are used to the cot mattress on the floor, you can move the mattress back into the cot.
  • Give your child some time in the cot when awake. This could be quiet play while you tidy clothes away, or you could sit and play with your child while they are in the cot. It’s important to make the time in the cot really low key and happy, and to lift them out as soon as they start to fuss. You want them to associate the cot with calm and connection!
  • Sleep on the cot sheets for a couple of nights before you transfer your baby into the cot! That way, when your child is in the cot, it still feels and smells familiar.
  • If your baby is over one, you can start offering a comfort object while baby is falling asleep in your bed, and then transfer that comfort object with them to the cot.

Getting your baby to sleep in the cot

Suggested age: any age – I suggest different techniques for different ages below.

If you can transfer your baby into the cot once they are asleep, then this is probably the easiest way to do it. I think transferring sleepy but awake doesn’t usually work great, except for the most relaxed and easy going of babies. If your baby is even the slightest bit alert, then this will probably result in them just waking up fully. If you are struggling to get your baby to stay asleep on transfer into the cot, you can try waiting a little bit longer, until they are in a deeper sleep. For younger babies with an exaggerated startle reflex the following video may be helpful: 

https://youtu.be/06RkN53mnaA

For a baby that isn’t sitting or standing (so, under six months), the following technique may be helpful:

https://vimeo.com/551437685/5fb18b865f

If you want your older baby to fall asleep in the cot, I’d try after your nap or bedtime routine, when they are calm but not about to fall asleep. The easiest times to try are bedtime and the first nap of the day. You can put them into their cot awake, and then give them as much support as they need in the cot. It might be helpful to lie down on the floor next to the cot and put your hand through the cot bars – this often encourages a baby to lie down to get closer to you. You can then use your sleep associations to help your baby fall asleep in the cot. Sometimes even offering MORE support than usual, with extra patting, shushing, etc helps. If you’ve managed to work up some distance between you with them falling asleep on the bed, actually getting closer to the cot and closer to them than they’ve been used to, may be helpful. It can then feel like you’re giving them more contact, even though the bars are between you. If they become upset, then you can lift them out of the cot, give them a cuddle, settle them down again, and then try again with putting them into the cot awake. If they get too upset, then at this stage you can try a “Dramatic wake up”. You can pretend that the nap is over, or that it’s time to get up, and take them back downstairs for 20/30 minutes or so until they are calm. At this stage you then decide whether you are going to try again with helping them fall asleep in the cot, or whether you’ll leave it and help them fall asleep in the usual way.

Video: stopping feeding to sleep/ night feeds

Stopping feeding to sleep

Suggested age: ideally over the age of 6 months

Feeding to sleep often gets a bad press and gets blamed for all sorts of issues. It’s a bad habit, it’s making a rod for your own back, it increases night waking… but actually, feeding to sleep is often the EASIEST way to get a baby to sleep. I’d go as far as to say that feeding to sleep is the only sleep association that can actually put your baby to sleep – all the other sleep associations merely provide enough calm for sleep to happen. Remember how I said your baby needs 3 things to fall asleep? To be tired enough, to be calm enough and to feel connected. Well, feeding to sleep often addresses all three components:

  •  Milk promotes sleep. Both breastmilk and formula contain tryptophan, which is an amino-acid and the precursor to seratonin (a feel good hormone). Breastmilk does contain higher levels of tryptophan than formula does, and also, tryptophan levels are higher at night time in breastmilk – hence promoting even more sleep at that stage! Breastmilk also contains melatonin, and in higher levels at bedtime than during the day.
  • Feeding promotes calm. The suck and swallow action of feeding stimulates the vagus nerve. The vagus nerve runs down the back of your throat and is your “calm down” nerve. When it is activated, your heartrate slows, your breathing slows and your blood pressure drops – perfect physiological conditions for sleep to happen. 
  • Feeding is usually a time of connection. Ideally you will be cuddling your baby as they feed to sleep. 

Of course, there are some drawbacks to feeding to sleep. Bottlefeeding to sleep is often associated with dental cavities in babies. Your health visitor has probably encouraged you to stop bottlefeeding to sleep and to move milk feeds to a cup, from around six months, for this reason. There could also be the potential for overfeeding if babies are bottlefeeding frequently overnight to help them fall back to sleep, rather than from hunger. For breastfeeding parents, if your baby only feeds to sleep you can really feel the pressure to always be there for naps and bedtime. So feeding to sleep can become problematic if your baby starts day care, or if you need to be away at bedtime. 

Is it a bad habit? I don’t think so. I think it is the easiest way to help your baby fall asleep and if it is working for you, there is no need to change it. It’s also worth considering your long term goals if you’re breastfeeding. Removing the feeding to sleep association may reduce the duration of breastfeeding. 

Does it increase night waking? Perhaps. It’s not entirely clear cut. If you remember back to the Sleep Science module, I mentioned that babies often wake up at the end of a sleep cycle and need help to get back to sleep. Because feeding to sleep almost invariably involves an adult, you will be more aware of your child waking at the end of a sleep cycle. If you stop feeding to sleep, your baby may still wake up at the end of a sleep cycle. If you’re lucky, they’ll have worked out how to fall asleep again without your help – so they may actually still wake up just as often, you may just not be as aware of it happening. And if they wake up and still need help to get back to sleep? Well, you’ve maybe just lost your easiest way to get them back to sleep and find yourself doing something else instead that maybe is more disruptive to your own sleep, or is more effort. 

It’s worth bearing in mind that if you change the feeding to sleep association at some points in the day, it doesn’t have to be all or nothing. You can stop feeding to sleep for naps if daycare is on the horizon, but continue feeding to sleep overnight. Alternatively, you could work on reducing the feeding to sleep association overnight, rather than at any other time. 

So, how do you stop feeding to sleep?

  • Make sure you have a few new sleep associations in place for 2-3 weeks first.
  • The easiest and most straight forward way to change it, might be just to move your feed to the start of your nap routine or bedtime routine, and then once you’ve done your routine, use your new sleep associations to get your baby to sleep. 
  • Remember, it’s sometimes easiest to make a change at bedtime (because of the double advantage of sleep pressure and circadian rhythm) and/or the first nap of the day. Then you can try at other times.
  • Would a dummy be an option? This may provide some comfort and calm to a baby, especially if they have already fed earlier.
  • If you are breastfeeding, you can try the “Pantley pull off” – a technique described in Elizabeth Pantley’s book The No-Cry Sleep Solution. You wait till your baby has moved into those sleepy flutter sucks at the end of a feed and then unlatch them. At this stage you may have to use your other sleep associations to help your baby fall asleep. If your baby starts to fuss, you can give them a few more sucks to calm them, unlatch them and try to get them to sleep without feeding. Remember, consistency and perseverance is key here – you may need to keep trying for a few days for it to work. Once your baby falls asleep easily when unlatched, you can try doing it earlier in the feed. Once they can fall asleep after a very short time at the breast, you might want to move your feed to the start of your bedtime routine.
  • Close the gap – babies that have been breastfeeding get used to the sensation of having something in their mouth as they fall asleep. You can watch the short video below for a demonstration on how to compensate for this:

https://vimeo.com/551453357/b48d2599f6

A word about pacifiers (dummies or soothers)

Some parents choose to use a dummy or a soother. If you introduce one early on, when your baby is still newborn, it is best from a safe sleep perspective not to get rid of it till around six months. This is because there is an association with SIDS and a pacifier being removed before six months.

After six months, there are a few options:

  • You work on removing the pacifier, in a similar way to the feeding to sleep process above.
  • You give it only as they fall asleep, and then remove it for naps and night sleep.
  • You teach your baby how to replace the dummy themselves! You could put a few in the cot and practice with them during the day time. You may need to place a few pacifiers in the cot overnight so they can find one easily.

If you decide not to get rid of the pacifier between 6 and 12 months, then it is probably best to wait until your child is over the age of two. Often, children develop an emotional attachment to a pacifier by the age of 12 months and it becomes much harder to get rid of it when they are toddlers. Ideally the pacifier should be limited to times when your child is sleeping, so that speech is not affected.

Stopping bottlefeeds at night time

Suggested age: not before six months

While milk is your child’s main source of nutrition it is likely that they will still need night feeds. We now encourage responsive bottlefeeding rather than feeding on a schedule. As babies have tiny tummies, it is likely that they will want to feed around the clock. There is no evidence that babies stop needing night feeds at a certain age – the comments you see about them being over a certain age, or a certain weight – there is no scientific evidence to back these up. There is also some evidence that night feeds help to boost brain growth. Remember, under six months milk satisfies hunger, thirst, as well as providing an opportunity for calm and connection. Therefore night feeds are still necessary. This is hard work, especially when you have to get up, get a bottle of formula ready, let it cool and feed a crying baby. If you do need to make up night feeds, you can either used premade formula (expensive) or you can fill a vacuum flask with boiling hot water for overnight. You then need to cool your bottle down before feeding. While it is tempting to reduce night feeds, to reduce the hassle of making up bottles, your best bet is to work on the Simple Sleep Solutions and Sleep Shaping to reduce the frequency of night waking that way, rather than try to actively cut out night feeds. 

You may be expressing and bottlefeeding your baby EBM overnight. If that’s the case, it may be helpful to take a cooler bag with bottles with appropriate volumes of EBM up to bed with you. EBM is fine in a cooler bag for 24 hours. If you remember to, each time you feed your baby, you can take a bottle out of the cooler bag for the next feed, as EBM is usually safe at room temperature for 4-6 hours. As a side note, if you are expressing overnight as well, it might be enough to only do it when your baby wakes to feed. However, sometimes your milk supply dips if you don’t pump at least once overnight. There is something a bit soul destroying about waking in the early hours of the morning to pump, while your baby sleeps on. 

Once a baby is over 6 months and you feel that solids are going well, you can try to reduce the night feeds a bit. You still need to make sure that your baby is getting enough formula or EBM in 24 hours, as milk is still their main source of nutrition until the age of a year. While this volume will decrease over the first year, it’s important to make sure that if you are eliminating night feeds, they are still getting enough milk at the rest of the time. It’s also important to realize that reducing all night feeds won’t necessarily stop the waking up – babies wake for a variety of reasons. You also may occasionally have to give them some extra milk overnight. Have you ever woken up at 3 am feeling thirsty? Imagine being a baby, and not being allowed anything to drink overnight! How uncomfortable would that feel! 

There is also a metabolic component to night feeds – babies wake hungry because their bodies are used to eating at those times. If you stop all night feeds suddenly, then your baby almost certainly will wake up hungry. If you can shift that metabolic need for milk gradually, it’ll be kinder and gentler on your baby. Also, if you find that your baby does still want milk overnight – perhaps think of finding one period of time overnight where your baby goes a little longer, rather than eliminating night feeds completely. Most parents find that giving a feed just before they go to bed (perhaps around 10/11 pm), and then another in the early hours of the morning (say 4/5 am) is reasonable. I prefer not to say exactly when a baby (or toddler) no longer needs night feeds, because I think it’s variable, from one baby to another. There is also no credible source of information out there that gives us scientific information on babies dropping bottlefeeds – it’s all anecdotal and driven very much by cultural expectations of babies (the baby books say that babies can stop night feeds) but there is nothing to back these claims up. If we take breastfeeding as the biological norm, then we know that breastfeeding babies will feed frequently, well in to toddlerhood. Perhaps we should be looking at a similar pattern for bottlefed babies.

A few options for reducing/stopping feeds:

  • Remember to introduce some other sleep associations.
  • Reduce the volume you give in a bottle – so say for example your baby feeds at 10 pm, 2 am and 6 am. You could start by reducing the volume of the 2 am bottle by an oz (30 mls) every 2-3 nights and then eliminate it once you’re down to 1 oz (30 mls).
  • Stretching the time between feeds – you can do this either by providing comfort in other ways when your baby wakes, or by offering dreamfeeds. So for example, you could try giving a dreamfeed just when you go to bed, and then using your sleep associations and/or a few sips of water at the next wake up, and then either dreamfeeding at a set time (say 5 am), or choosing to bottlefeed at the next wake up, whatever time that is.

Night weaning – breastfeeding

Suggested age: no active reduction in night feeds under the age of 6 months, partial night weaning only between 6 and 12 months, full night weaning may be ok after 12 months, but it might be easier to wait for full night weaning till 18 months.

As an IBCLC, I’d recommend not reducing night feeds at all under the age of six months. If baby wakes overnight, then I’d always recommend offering a feed. If your baby is feeding very frequently overnight – for example, waking every 45 minutes for feeding – it might be worth having a breastfeeding assessment rather than booking a sleep consultation. 

If your baby is between six and 12 months, then I think they almost certainly need some night feeds, unless they spontaneously stop feeding at night time themselves (which is highly unlikely). If your baby is waking every 2-3 hours for a feed, I’d be inclined not to change too much. If they are waking every hour or so, then I’d work on the Simple Sleep Solutions (in particular, make sure your baby is feeding frequently enough during the day) and Sleep Shaping first, before actively reducing night feeds. Remember: some parents find that their milk supply is very sensitive to night feeds, so eliminating all night feeds may result in a drop in milk supply. This can usually be easily remedied by re-introducing a night feed if necessary. 

Some ideas include:

  • Dreamfeeds – this can be a really gentle way to stretch the feeds out over night. Often babies don’t even realize they are being night weaned. You’d dreamfeed more often at the start of the night and then give yourself a longer stretch overnight, gradually increasing the time between dreamfeeds. This works well if your baby isn’t waking up too often overnight, and has fairly predictable wake ups. 
  • Core night stretching – you’d pick a chunk of the night where you decide you’re not going to feed, so you might feed as normal between bedtime and midnight, and then decide not to feed between midnight and 4 am. So for that time period you might give sips of water, and use your sleep associations to get your child back to sleep. You might need to start with a shorter chunk of the night and then gradually make it longer as your child (and your boobs!) adjust.
  • Reducing length of feeds overnight – this approach means you have to be fairly awake when you feed your child, as you are going to have to reduce the time you spend feeding overnight. So for example, if you usually feed for 10 minutes overnight, you can gradually reduce the length of the feed, say be 2 minutes every 2-3 nights. It’s also worth bearing in mind that you might need to work on the feed to sleep association, if your child is used to falling back to sleep on the breast overnight, as you will probably have to use sleep associations to finish getting your child back to sleep, after they have had a shorter feed than normal.

Video: Stopping motion and self-settling

Stopping motion for sleep (rocking, slings, prams)

Some babies just love movement to help them fall asleep! It’s not usually so hard to rock them to sleep when they are tiny babies, but it definitely is a lot of effort when they are toddlers. I’ve also known parents to walk for miles, 2 or 3 times a day, just to keep their baby asleep in a pram. So how do we move away from it?

  • As always, try at the easiest times of the day first: bedtime and the first nap.
  • Make sure that you have some new sleep associations in place.
  • Make sure that they’re really tired and that sleep pressure is high.
  • Gradually reduce the intensity of the rocking, from a vigorous rock to a gentle rock, to just holding.
  • Try a “stop and start” technique – start rocking and then as they settle and get sleepy, stop the movement for 30 seconds. If they protest, start up again. Then when they get sleepy, stop the movement again. The idea is to gradually decrease the length of time rocking and increase the length of time standing still. This can work well for prams and sling naps too, although it will look a little weird if you go for a walk and stop and start!

Self-settling

Should you work at getting your baby to self-settle? Honestly, under the age of 18 months I think it’s quite difficult. Unless you have a really chilled out, adaptable child, you might find it easiest to optimize naps and bedtime so that sleep happens within that 15-20 minute window, and then find a balance with some sleep associations that you can support your child with. So for example, you may choose to lie near your child and pat them until they fall asleep. However, if you need your baby/toddler to fall asleep on their own, the easiest way I’ve found at this age is to use an “elastic band” approach.

Say for example, your child has got used to falling asleep in the cot with you sitting next to them, patting and shushing them. You also use some other sleep associations, for example, a muslin that you’ve had next to your skin, tucked over the mattress, plus pink noise. In order for your child to fall asleep on their own, you need to be able to remove the patting and shushing first. So, you’d maybe use everything except shushing. If your baby fusses, you add in shushing just until they are calm, but use your other sleep associations to try to get them to sleep. For the first few nights, you have to cycle between shushing and then being quiet. Once your child can fall asleep without shushing, it becomes quicker each night to get them to sleep without having to add it in. (Remember, sometimes they have a little “blip” after a few nights when they get fussy again, and you might have to add shushing back in just for comfort, but try not to use it to help them fall asleep.) Once they have adjusted to falling asleep without shushing, you can try to get them to sleep without patting, but you will have to add in a bit of patting if they get fussy. You then work on getting them to fall asleep without patting, but only using it to calm them down. Once you have got them used to that, I’d try standing near their cot, stepping away for a minute, then stepping closer to the cot. Each night you can try stepping a little bit further away, before stepping back to the cot. Ideally at this stage you don’t want your baby to fuss, but just to get used to you stepping away, but coming back again. As long as they know you do come back, they should stay calm and relaxed. At some point, they’ll fall asleep when you’ve stepped out of the room.

And finally…

This is the end of the course! I really hope you’ve enjoyed it and found it helpful. Hopefully, you’ve found enough information in these modules to make gentle, responsive changes to sleep. If you’d like any further support, please don’t hesitate to reach out. 


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