Sleeping FAQ: 4-6 months – Night Waking

My five-month-old premature twins are still waking in the night and needing water to settle

I have twin girls who were born two months prematurely. They are now doing well on the routines, presently following the one for three months, but they continue to wake in the night around 3/4am. During the day they feed at 7am, 11am, 2.15pm, 6.30pm and 10.30pm, taking between 130-150mls at each feed. They each weigh 6.5-7 kilos. The girls nap at 9-9.45am, 12-2pm and sometimes they need 15-30 minutes in the afternoon. They settle by 7pm. We wake them at 10pm, feed them at 10.30pm and put them to bed around 11.15pm, trying to keep them awake for at least an hour.
The problem is that their daily milk intake has always been less than it should be for their weight. Their total daily intake is around 700-750mls between 7am and 11pm, yet their weight gain is normal. For the last three weeks I have started to use the “core night” method, giving them only water when they wake up. This seemed to work at the beginning, pushing their waking time to 4.30-5.30am for a couple of nights, but there is no pattern to it, and sometimes they sleep until 7am but at other times they wake around 6am. I wonder if the problem could be due to their daily milk intake being low? Maybe this is an issue for premature babies, or perhaps drinking water in the night becomes a habit?

Getting your girls to sleep right through the night, without waking and without the need for water, may mean trying to increase their daily intake by using split feeds. Between three and four months there is often a growth spurt. Bearing in mind your daughters’ prematurity, this is a likely reason why they cannot sustain going through for more than a few nights. To help them take a good feed at 10pm, continue to wake them at this time but split the feed into two, adding an extra 30-60mls to each bottle. To do this effectively, you may need to wake them around 9.45pm in order for them to be ready to take the first half of their feed at 10pm. Make sure they are well awake before giving it to them. Once finished allow them to have some quiet kicking time until 11.15pm. Although you need them to stay awake, don’t over-stimulate, as you need them to settle down easily. At 11.15pm change them and then give each of them the second half of their feed in their room, with the lights dimmed. This lengthened period of being awake, with a slightly bigger feed, should help them to push on further in the night. It is best to make this feed in two bottles so the one offered at 11.15pm will be fresh, without stale milk tainting the teat. If the girls begin to stir at 3/4am, leave them 5-10 minutes before going in, to see if they are able to settle themselves back to sleep. As they have shown, they are able to get through the night without milk, so see if you are able to settle them without giving water. You may need to hold them for five minutes to let them calm themselves into sleepiness again.

If they are in sleeping bags, make sure they are well tucked in with a sheet placed lengthways over them, and well secured at each side. The Moro reflex can still be strong at this age, and when the girls enter a light sleep cycle, it may disturb them enough to wake fully. Until a baby is sleeping through the night from 11pm to 7pm, and has consistently done so for two weeks, it is better to split the feed at 5/6pm. As your girls have a low daily milk intake, they could benefit from this. Again, by taking a feed in two parts you may be able to encourage them to take an extra 30-60mls, which will help them to sleep through the night. It also means that they do not take too big a feed at 6.30pm, which in turn may cause them to have a smaller feed at 10pm. Once they have slept through on a regular basis for two weeks, you can gradually reduce the amount given at 5pm, dropping it back to one feed at 6.30pm when you feel they are able to get through the night without waking. Please refer to The Contented Little Baby Book p 87 for a question and answer about this split feed. Once you have established a more regular nap schedule, you may find he is more willing to play for short spells by himself during the day. At this age it is realistic to expect a baby to be able to play on his own contentedly for 15-20 minutes at a stretch. As he is not used to doing this, you may need to build up to this time. Encourage him to play by sitting next to him and talking about what he is doing. Don’t always show him how a toy works, but encourage him to find out for himself. If he begins to fuss, try not to pick him up straight away. Encourage him with your voice, “Hi there. I can see you. Where’s your blue teddy?” and when you do go over, sit next to him and show him something new to see if he is able to engage with something again for a short spell. It can take time for a baby to learn how to play alone, especially if they are used to a lot of interaction, but with gentle encouragement you will be able to get him to play for short spells alone, and these will become longer as he gets older.