Sleeping FAQ: 4-6 Months – Night Waking

Since traveling I have been unable to get my 4mth son back onto a routine. He is waking hungry twice in the night

My 4 month old son is struggling to sleep through from the last feed at 10 – 10:30pm until 6 -7 am.
We started him on the routines at 4 – 7 weeks quite successfully – he really responded well.
But at 7 week we traveled to Australia from the UK, and for the next 6 weeks it was incredibly difficult to stick to the routines. For a start, it took him 10 days to swop day and night around, it was extremely hot, and nobody supported our decision to have a routine. We also traveled in Australia, long drives in the car leading to oversleeping and also jumping time zones. All the time I tried to get him on the routine. He also had some of his 8 week immunizations in Australia. He wasn’t very difficult throughout the whole trip, as him ‘own’ routine is not far off yours. But since coming back to the UK almost a month ago, I have not been able to get him on a routine. He was quite content until a week ago and now he wakes twice during the night seemingly hungry, he seems to also want solids but I’m confused as to whether I should first get him to have a routine for his age, or to try to introduce a bottle or solids. He won’t take water or formula or expressed milk in a bottle at all.
Overall he is bright eyed, laughs a lot & is interactive, wants to stand up and look around most of the time, and plays for short periods with toys on his mat.
I’m struggling to cope emotionally and physically with little sleep, and can’t always wake at 10pm to wake him, when he only feed for about 5 – 10 minutes.

My son breast feeds at 7am Breast last fed from 10mins, second breast 10mins. 9am cries for food, sometimes can wait until 10am. 10-11am 10mins from breast last fed on, 20mins second breast. 2pm 10mins and 20mins, 5pm one side, 6.15pm second side, 10.30pm drinks for 5mins, 1-2am feeds for 10mins, 3-4am feeds for 10mins.

My son weighs 6.4kg [14.1.5lbs]

He naps at 8.15-9am, 12-1pm, 4-4.45pm and settles by 6.30pm

If you look at your son’s sleeping pattern you will see that, at present, he is sleeping his longest stretch from 6.30pm to midnight. If you can make sure your son has a good 10pm feed you will then be able to work on dropping his first night feed. Many babies of this age can be very sleepy at 10.30pm and so take a small feed at this time. Until your son feeds better at this late evening feed, especially as he is fully breast fed, he may well wake twice in the night.

Your son needs to be really awake by 10pm to take a proper feed. You or your partner need to start waking your son at 9.45pm. Turn on the lights in his room and remove the cot covers. It may take your baby 15-20minutes to fully wake up but, once he is fully awake, offer him the first side. Feed him in a room which is light and has some background noise so he stays awake. If he begins to get sleepy whilst feeding, unlatch him and place him down on his play mat. Being away from the warmth of your body will bring him round and he will be ready to resume feeding. Change his nappy when he has finished on the first side. If you can, keep him happily kicking for 10-15minutes as this will help keep him awake and he should be happy to take the second side around 10.45pm. It can be difficult to do this when you are tired yourself but the better your son feeds at this time of night the more likely he is to settle well and have a longer stretch of sleep before needing his next feed.

It would help you if you can really work on getting him to take a bottle as you will then have the option of offering a fully expressed or formula feed at 10pm and can be sure he has had a full feed.

If your son is not used to a bottle by now he may take a while to accept it but try using a bottle with him on a daily basis. The feed at 2.30pm may be a good feed at which to introduce the bottle, as your son will be both hungry and wide awake. If he cries when offered the bottle, don’t keep taking the teat out of his mouth as this will make him cross. Make sure the bottle you are using has a teat where the milk flows quite quickly. Once he tastes the milk on his tongue he may be encouraged to suck. Often a soft teat, such as that sold by NUK, will work better at the beginning for a baby who is reluctant to take a bottle. Make sure you sit him upright when offering the bottle, and warm the milk to at least body temperature. Test the milk by dropping a few drips on the inside of your wrist to make sure it is not too warm.

It may help if someone else gives a bottle to your son until he gets used to taking one. This is because he associates you with breast feeding and so may be more resistant to you offering a bottle. It is often best if you are not even present in the room as by this age your son will be well aware of you looking on. Once he has realized that milk comes from a bottle as well as a nipple he will take a bottle from you as well. If it is not possible for someone else to offer a bottle in the day then do this at 10pm, if your partner is willing to try, using either a fully expressed feed or formula.

If you need to sleep in the evening try to be in bed by 8pm so you will have had two hours sleep before getting up again. It is very difficult to wake if you are in a deep sleep which will happen about an hour after going to bed. You need to get up out of bed to feed so you need to make sure you are properly awake as well.

Once you know that your son has had a good feed at 10pm you will be able to begin to use the “core night” method to help him stretch out for longer before needing his next feed. This is explained on page 148 of The Contented Little Baby Book and page 42 of The Complete Sleep Guide.

If your soon feeds well at 10pm then he should be able to drop the first night feed. But as he is fully breast he may continue to need an early morning feed around 5am/6am until he is weaned.

During the day your son appears to feeding and napping fairly well. Try and keep him going in the morning to nearer 8.30am/8.45am before putting him down for his nap. You may find that topping and tailing him at 8am and getting him dressed for the day will encourage him to stay awake longer. If he does fall asleep around 8.30am and sleeps to 9.15am you can keep the day on track by giving him an extra catnap at 10.45am. See page 136 of The Contented Little Baby Book where this is fully explained.

If your son has fed well at 7am he should be able to get to at least 10am before needing a feed. Make sure he is fully emptying your breasts at the 7am feed, even when he has fed at 3am/4am. Use the same technique as explained above (for the 10pm feed) for encouraging him to continue to feed should he become sleepy.

To help your son sleep well at the lunchtime nap, especially if he is feeding by 10am, offer him a top up feed before he goes down at 12 midday. This should help him to sleep to nearer 2pm/2.30pm. If he has slept earlier in the morning, from 8.30-9.15am, and then had a short cat nap at 10.45am you may find he can wait until 12.30pm before going down. Still offer him a top up feed at this later time as hunger is one of the most common reasons why the lunchtime nap goes wrong and a baby wakes after an hour.

Getting your baby to have a good lunchtime nap will allow you to rest at this time as well. If you are very tired at present your milk supply may be affected so it is important to get as much rest as you can in the day. Also, if your partner is willing to give the 10pm feed you will be able to go to bed in the early evening, once you have expressed, and get some much needed rest.

At present your son is awake for 3 hours between 9am and 12 midday which may be the reason for his short lunchtime nap. He is overtired and unable to sleep for longer. Make sure he is well tucked in to his cot, even if he is in a sleeping bag. Use a sheet and light cotton blanket across him if he is wearing a bag of 0.5togs. Using the lightest weight bag is recommended at this age as the Moro reflex can still be strong so causing a baby to wake himself when in a light sleep.

The present guidelines suggest that weaning takes place nearer to six months. If you feel that your son is showing all the signs that he is ready to move on to solids before this then discuss the situation with your health visitor. The signs that he may be ready to wean can be found on page 88 of The Contented Childs Food Bible.