Sleeping FAQ: 4-6 months – Night Waking

My 4 mth premature son has wind problems, which makes it hard for him to settle, and he is waking earlier at night

My son was born nine weeks prematurely and suffered with breathing, gastric and digestive problems. I began the routines from his EDD, which was eight weeks ago; he is now almost four months old. The routines were going well until he suffered from a stomach bug two weeks ago and he has since had trouble settling.
He has problems with wind when he is sleeping, despite a long period of winding before putting him down. He was going through to 5-6am, but is now waking around 3am. I have reduced this feed to 3oz, then 2oz, but he is waking earlier very hungry. Due to his sensitive stomach and digestive system, it is difficult to give him any wind remedies. His sleep is often very broken, particularly at lunchtime, which results in a grumpy baby by 4.30/5pm. He is even becoming increasingly difficult to settle after his 7pm feed. He cat naps around 8am, then gets overtired and is difficult to settle at 9am. He wakes at 10am and is hungry, unable to wait until11am for his next feed.
He feeds at 7am – 6oz; 10.30am – 6oz; 2.30pm – 5oz; 6.15pm – 6oz; 10.30pm – 5oz; 3.30am – 2oz. He weighs 10lb 5oz and naps at 8.45-10am, 11.30am-2.00pm and 4.30-5pm.

As your son has problems with wind and other gastric issues, you could try splitting some of his feeds into two, so offering him his milk over a greater period of time. For his weight his intake is very good, but by spreading his feeds over a longer period he may be more content and comfortable. It could also help him sleep longer in the night and reduce his need for the middle of the night feed.

After his recent illness he may have had a growth spurt, resulting in the earlier waking at night; this often happens as a baby recovers. As your baby is unable to wait until 11am for his feed, give him half of it when he shows signs of hunger after waking from his nap. Then let him have some time sitting in his chair to allow him to digest his milk. Around 11.15am offer him the second half. This may help him settle better at his lunchtime nap as it rules out hunger as one of the possible reasons for him being unsettled.

By splitting the feed at 10pm and keeping your son up for longer, he may stretch himself in the night and be less likely to wake through hunger. Wake him at 10pm and offer him the first half of his feed. If he takes a while to wake at this time begin to do so at 9.45pm to allow him to fully waken. After this feed, let him have a break to help him digest this milk. He can spend some time kicking on the floor or on the bed. Keep the lights on and don’t worry about background noise, as you are encouraging him to stay awake, but don’t over-stimulate him. At 11.15pm change him and offer him the second half of his feed; use a fresh bottle to avoid any stale milk contaminating the teat. Then settle him for the night. When he wakes at 3am you could try to offer him some cool boiled water and see if he will settle for longer. This is the “core night ” method explained on p 148 of the Contented Little Baby Book.

As your son was premature, he may take longer than average to sleep through the night. But by using this method you will gradually extend the time of the feed. If he begins to show signs of not being interested in his feed at 7am, you will know that he is ready to go through the night without the need for milk. Getting a small baby into a routine can take time and persistence. The sleep needs of a small baby may be more than those suggested. To encourage him to stay awake first thing in the morning after his 7am feed, change the scene for him by letting him kick for a short while, then sit him in his chair while you have breakfast. Then perhaps have some time on his changing mat while you top and tail him. Kicking on his mat with no nappy on will encourage him to stay awake until nearer 8.30am before becoming tired. Most babies really enjoy being on their mats and it is a good way to stretch out the time he stays awake. Before he becomes too tired take him to his room and have a twenty-minute “wind down” where you gradually prepare him for sleep. This may involve looking at a book, looking out the window or singing a song. It will help him to relax and settle himself for a 45-minute nap. It can take time for a baby to learn these skills, but by doing the same thing everyday they will learn. A lot of babies of your son’s age do need a nap in the afternoon, but as long as he is awake by 5pm, let him have this nap for as long as he needs it.