Sleeping FAQ: 0-8 weeks – Settling/Sleep Associations

At 4 weeks my son needs his dummy to settle to sleep

I have a 2 yr old who has been a “Gina” baby since 3 weeks, and is a perfect contented child. However my little baby boy has been so unsettled. His first two weeks were fine, but his naps went wrong in the third week and everything has gone down fast. He seems very sucky and we have resorted to a dummy which upsets me greatly. I am so worried about keeping his feeding and sleeping on track. He now relies on a dummy all the time at every sleep. Last night I put it back in twice. Do I stick with it even though his sleeping is interrupted with it falling out?
I find wind down time difficult, as I can’t leave my daughter downstairs while I settle him.

Today is the first day when he has taken the right quantity of milk. I did controlled crying, cold turkey, on my daughter at 3 weeks for her 7pm sleep and it worked. Is he too young? Should I stick with the dummy until he is older? I really would appreciate some advice.

Last week he weighed 8lbs. His birth weight was 7lbs 8ozs. He feeds at 6-7am 3ozs, 9.30am 3ozs, 2pm 3-4ozs, 5pm 2ozs,6pm 2ozs,10.30pm 3ozs, 3-4am 2-3ozs. If he wakes after 4am I give him 1.5ozs.

At three/four weeks your son could well be having a growth spurt. It is not uncommon for babies of this age to “wake up to the world” and be more unsettled than they have during the first two weeks of life. He is taking in much more, both with his feeds and all his senses, as the world around him becomes more interesting. Learning how to settle to sleep and shut out the world can take some babies a while. As he is a “sucky ” baby, using a dummy to settle will have to be carefully monitored on your behalf to prevent it becoming associated with sleeping.

Check that hunger is not causing him to wake in his lunchtime nap, by giving him a top up feed before going down. From your notes he would appear to be feeding at 9.30am and then again at 2.30pm. At his age this is too long a stretch inbetween feeds. At 8+lbs he still needs to feed every 3-3.5 hrs in the day. A lot of problems with newborn babies settling, are ones of hunger. Although you wish to settle him into a routine, it is very important that you supply his needs for feeds until he is regularly gaining 6-8ozs each week. Have a look at the routine for a one week old, which is nearer to your son’s needs at this weight.

A good idea for you to cope with daytime naps would be to make up a “busy bag” for your daughter. Put some toys which are new to her into it. Use things such as a magic drawing slate. Have a supply of small things which you can swap around every few days, so she is never quite sure what she find in it each day. This bag becomes part of your routine in putting down your son. When he is ready for wind down time take them both upstairs along with the bag. Depending on safety issues you may be able to leave your daughter outside her brother’s room occupied with her bag. Talk to her through her brother, telling him it is time to be quiet and settle to sleep, as if you ask her directly to be quiet it may have the opposite effect and she will become noisier. If she needs to be with you in the room, let her be by the door and have some light to see her toys whilst you sit quietly with your son.

Is he swaddled? If not, he may benefit from being swaddled and tucked into his cot very securely so his Moro reflex does not disturb him. Let him have his dummy to calm down, but try to remove it once he is sleepy and settled in his crib. Already he is associating it with sleep and is beginning to wake without it. It would be best to address the problem now before it escalates even more. Begin by removing his dummy before he is fully asleep and gradually working towards taking it away when he is calm, but not asleep, will take time and perseverance but is worth doing.

Take your daughter out of the room but stay upstairs with her, perhaps sorting laundry or playing in her room. Give your son 10 minutes to settle himself and then return to him for a minute or so to reassure him by stroking and “shushing” if he is still not asleep. Continue to return to him every 10 minutes. If he becomes very distressed, then pick him up and hold him until he is calm, but try not to resort to using the dummy to get him sleeping.
Controlled crying, where you lengthen the times you go into your baby, is best left until a baby is older. At this age keep going back after 5-10mins to reassure him and picking him up, if he is getting very upset, to resettle him. Look in the Complete Sleep Guide page 26 for details about how to settle a small baby. It can take some babies several weeks to really learn how to settle themselves alone.

During the night it would be better if you could not let him fall fully asleep with his dummy, as this is causing you to have to get up to him several times. Make sure you give him the last part of his 10pm feed in a darkened room. If you are sure he has fed well and is winded, then hold him until he reaches a state of sleepiness before putting him down. Again, if you feel he needs his dummy to calm him, then use it but begin to withdraw it before he gets too sleepy. Continue to hold him until he is calm again and then settle him in his cot, making sure he is very securely tucked in.

For several nights you may have to resettle him by holding him again if he wakes, and is distressed but not hungry. Get your partner to help you with this. Getting him used to falling asleep without any association, will take time, but it is worth doing now rather than in a few months time. There is a case of a slightly older baby with dummy dependence in the Complete Sleep Guide p 82, which may help you. As you are already aware of the problems that a dummy can bring, it may help you to be persistent in tackling the problem now.

Sleeping FAQ: 0-8 weeks – Settling/Sleep Associations

My 5.5-week-old daughter seems unable to settle properly between 7and 10pm

My daughter is a great baby and follows the routine like clockwork except for the following: most nights she only sleeps for one hour at the 7pm sleep i.e. waking up at 8pm and will not settle for the next 2 hours before the 10pm feed.
I have tried feeding her when she wakes up but this does not seem to satisfy her; I have tried giving her the dummy to console her; it works but as soon as I take it out she will unsettle again (this is the only time I use the dummy). I am really confused as to why she is waking up as she sleeps really well at all her other sleeps and for the recommended time as per the book. I don’t think she has cramps as she is not arching her back she is just crying.

I am also struggling with leaving her arms out of the swaddle, 9 out of 10 times if I leave her arms out she will not settle; if I swaddle her fully she is asleep within 20 seconds.

One thing about my daughter is that she is a really fast feeder; she can feed in 15-20 minutes. At first I questioned if she was getting enough food but I think she is as she does not demand food any earlier than the suggested times and she has gained weight accordingly.

At present she breast feeds at 7.30am 20mins one side, 10.40am 20mins one side, 2.30pm 25mins one side, 5.00pm 15mins one side, 6.15pm 25mins one side. 9.50pm 130mls expressed plus 5mins on one side if I have expressed both sides, 4.30am 10mins of good feeding and 5mins slow on one side. She weighs 9.3lbs.

She naps form 8.45- 10.05am, 11.50-2.20pm and 4.15- 5pm. She is settled by 6.40pm

As you are fully breast feeding your daughter you may find that by 6pm your supply is running low. This is a common problem for new mothers as it is difficult to get everything done in the home, rest and take care of the baby. Sometimes it is easy to forget to drink inbetween feeds and often a mother will not eat from lunchtime until supper, but still continues to have to feed her baby. Make sure you have something to eat around 4.30/5pm as well as drinking a glass of water between all feeds. Having something to eat at teatime is a habit all mothers should get into. Coping with babies and small children at this time of day can be very wearing. Giving yourself a boost of energy through eating some fruit and nuts, a slice of toast with a healthy spread or a slice of malt loaf can really help you.

To try to settle your daughter in the evening, so you can have a much-needed rest, offer her a top up of expressed milk before she goes down at 6.45pm. This will help her to really fill herself up. By this time of night she is tired and may appear to be taking a good feed but probably is quite sleepy at this time. This coupled with your supply, which is probably lower at this time, will result in her not feeding enough to last until 10pm. Some mothers find it easier to make the 6.15pm part of the feed a full expressed one. They will offer both sides at 5pm and then give a bottle of milk expressed earlier in the day after the bath., so they know that their baby has had a good feed.
Make sure your daughter is really awake before she starts to feed at 5pm. Being fully awake for the two hours before bedtime can really make a difference as to how a baby settles in the evening.

At 5.5 weeks your daughter will still like the security of being swaddled. To begin to wean her off this, start by leaving one arm out at her morning nap. Once she is used to this you can do the same thing at 7pm if she is then settling well, and then use the same way of swaddling her at her long lunchtime nap and finally throughout the night. Once she has got used to having one arm out at most of her naps, leave her with both arms free at the morning nap and gradually introduce the idea to her in the same order as before. Aim to have her half swaddled at all sleeps by the end of eight weeks. Half swaddling, where both arms are free can be used until you decide to introduce your daughter to a sleeping bag. This is best done at about 12 weeks.

Sleeping FAQ: 0-8 weeks – Settling/Sleep Associations

At 6 weeks my son cries before his naps and also if he wakes during them

My son does a lot of sleep-related crying. He is fine when feeding and during activity (even when in his cot) but when it is ready for a nap/sleep we take him to his room, switch off the lights and close the blind he starts to cry. He cries and cries if left in the cot (for half an hour with no sign of letting up) so I hold him until he calms down, which takes about 20 minutes. We then put him in the cot where he might sleep. If he wakes up we have to start the process again, sometimes this lasts his entire sleep period.

If he wakes during his sleep (sometimes possets, sometimes burps, rest of the time no idea what is the problem), we have the same problem and have to calm him before he will sleep again, which takes 10-30 minutes.  At the end of his sleep he sometimes wakes up cranky and cries before being fed.

We do not think that he is in pain because he will drop off to sleep eventually. The health visitor doesn’t seem interested at addressing the problem until we get to three or four months. We would like to stop him getting so distressed, get more sleep and make nap times in particular less of a chore.

At present he is breastfed, taking 45minutes on the breast at 7am, 10am 2pm and 5pm. He feeds for 10-20 minutes at 6.15pm. At 10pm he takes 4ozs formula (he won’t take more) and feeds for 10-30 minutes at 3am. He weighs 11lbs. At present he naps at 8.45-9.30am, 11.30-1.30pm and 4-4.30pm. He is settled by 7pm.

It would seem that your son is getting overtired and so fighting sleep when put down. A baby of this age may stay awake for up to two hours but many are ready to settle well before this. This is quite normal and as he grows he will be able to cope with being awake for slightly longer periods. Some babies of six weeks may only manage an hour or an hour and quarter.

Although your son may not be showing the signs of tiredness take him to his room at least 15 minutes before his usual nap time. Take this time to wind down. Sit with him quietly in a darkened room and let him learn how to relax before falling asleep. If you swaddle him at naps and sleep times do this before you start wind down time. It can take a baby of this age at least 20 minutes to go from being awake to being ready to sleep. He may protest at first but if you hold him against you, with no eye contact and remember to relax yourself he will learn how to calm down. Some mothers like to use a dummy at this stage as it helps their baby to calm enough to become sleepy. It may take a few attempts for your son to learn how to hold a dummy in his mouth, but used just for calming it can be helpful with a baby who finds relaxing to sleep difficult. Sitting in a comfortable chair will help you, as a young baby can sense tension and anxiety in others and so remain tense and unsettled themselves. If this whole winding down process starts too late, at the time when he needs to be asleep your son will begin to fight and fuss so lengthening the time he takes to settle and then sleeping more fitfully.

Look at the question and answer on page 86 of The New Contented Little Baby Book which describes this in detail.

You will not be cuddling your baby into a deep sleep but helping him become sleepy and so able to settle himself down to sleep. As he gets more able to do this himself you can begin to put him down when more awake than sleepy. It may take another few weeks before he is ready to do this. He may cry once you put him into his cot, but provided he is well-fed, winded and not over-tired he will settle himself within ten to twenty minutes of fussing and crying. Leaving a baby to cry persistently for any longer than this at this age is not advised.

In The Complete Sleep Guide Gina writes about crying down, which is how an over-tired or over-stimulated baby finally settles to sleep. See page 39. The more over-tired a baby is the more they will fight sleep so making sure you start the process early enough should help your son become more settled and able to sleep through his nap times.

If your son is happy to lie on his back after feeds, and does not seem in pain either during or after a feed you may find using gripe water or Infacol could help him have less disruption in his sleep. As he grows he should find it easier to bring his wind up and not be so bothered by it. If you feel that the problems he has with wind and possetting are not improving as he gets bigger then ask your doctor to check him over for any gastric problems.

The amount of formula feed your son is taking at 10pm is adequate for his needs. Providing he is settling well afterwards and getting to 3am before needing to be fed again he should not be forced to take any more. He will still need to feed in the night for a few more weeks yet. The time he wakes for this feed may gradually push on but unless he is beginning to lose interest in his feed at 7am let him feed for as long as he likes when he wakes in the night. Again, if he settles back to sleep again quickly and is not waking until 7am or having to be woken at this time, the amount he is taking is sufficient for his needs.

Sleeping FAQ: 0-8 weeks – Night Waking

My 4-week-old baby is unsettled and uncomfortable from 4am

My 4-week-old son is nearly on the CLB routine all the way through. The main problem is the period from 2.30am-7am.
He feeds well before and after his bath at 6pm and wakes at 10pm for a expressed/formula feed of 120mls. He settles until 2.30am. When he wakes I give him a short breast feed (25mins one side) and settles until 4am. He then wakes and spends until 7am in “pain” (due to wind?). At this time he is generally uncomfortable and does not sleep. He gets sleepy after each explosion but only for a short while as the next one follows fairly quickly.
By day he is very windy which also disrupts his daytime sleep and he requires immediate comforting after each “movement”, otherwise he gets very upset and takes a long time to settle again. He was on Infacol to alleviate this problem, but we have stopped giving it as he appears to be getting worse; it was given for 2 weeks. Vomiting does not appear to be a problem although he does posset a lot.

At present he feeds at: 7am breast, 10am breast, 2pm breast, 5pm breast, 6.15pm breast. 10pm 80-100mls expressed and 20mls SMA. His problems with wind started before this was introduced. 2.30am breast, short 20-25min feed, 4.30am one breast if woken up or is awake and hungry. He currently weighs 3.87kg (8.8lbs).
He sleeps from 9-10am, 12-2.00pm and 4-5pm.

The problem that your son is having with being uncomfortable in the early hours of the morning is not uncommon. Often a small babies digestive system does not always develop at the same rate as his appetite and gets rather “overloaded” at times. Whilst some babies are able to cope with this and sleep on, others are not.

Try elevating his cot or crib at the head end by placing telephone directories or a decent pile of books under each leg. Being in a slightly sloping position as opposed to lying flat, can help a baby eliminate wind and bowel movements slightly easier.

Dr Spock believed that the reason for fussing and fretting is that the stools of a very young baby are so soft, they do not put enough pressure on the anus, making them more difficult to eliminate; it is something he will grow out of as his systems mature. Once he is taking solid foods things may well improve a lot.

Keep a food diary of what you eat and see if these episodes are worse after dairy (in excess), citrus fruits -drink apple rather than orange juice- mushrooms and tomatoes. These four items may be the cause of excessive wind in babies. It takes 12-16 hours after you have eaten something to cause a bout of windy crying in a baby if they are being affected by it. Also watch your caffeine intake; drinking too much coffee, tea and chocolate can sometimes cause irritability in babies. If you feel there is a pattern to his behaviour with your diet, try cutting out the particular food for several days. If you notice an improvement then keep off it for a further week before gradually reintroducing it. If you are concerned that your diet is having an effect on your son, then discuss your concerns with a health visitor or doctor.
Are you happy with his position at the breast? Incorrect positions can lead to a breast-fed baby being more bothered by wind. Keep him tummy to tummy using two pillows if necessary for support. Holding him at the angle used for bottle feeding may cause him to take in more air than necessary as his latch is not so good. Ask a local NCT counsellor to check this out if you are concerned.
As you have already tried Infacol without success it may be worth considering Colief. This is available from Boots and is more expensive than Infacol. It breaks down the lactose in milk which some babies have trouble digesting. It can be given with both breast and formula milk. This could be worth considering, once you have been through all of the above.

Finally check that your son is really well tucked in the night. Use a sheet over his swaddle or sleeping bag, and secure it well with two rolled up towels down the sides of the cot spars.

Sleeping FAQ: 0-8 weeks – Night Waking

My 5.5-week-old baby is unable to settle herself to sleep and is still waking at night

My daughter is 5.5 weeks old and was born 6.9lbs and now weighs a healthy 9.2 lbs. I have been trying to follow the routine from 2 weeks and have also resisted creating any bad sleep associations as I did with my eldest daughter.

The problems are still the same. She is unable to settle herself to sleep. I have tried “crying down” but the cries escalate and do not subside; when they do she goes quiet for about 5-10 minutes and then she starts up again ; this can go on despite reassurance for brief moments every 10-15 minutes. I have resorted a few times to using a dummy but find that ,although this sends her off, it does not keep her asleep. I am still refusing to rock her to sleep and am also reluctant to nurse her back to sleep. What am I doing wrong? I catch the first yawn, or else make sure she has not been up for more than 1.5 hrs. I cannot make her room totally pitch black but do shield her eyes when initially settling her. I then put some lullaby music on and then let her get on with it. I have also tried topping her up to make sure she is not hungry.

There is also another issue where she is still waking up 2am and 5am for feeds and from then onwards seems unable to stay asleep and grunts and wriggles and whines. This has the knock-on effect of her not feeding brilliantly first thing and also needing a much earlier morning nap.

What are the exact steps for teaching her to settle? I am prepared to let her cry as I know how important it is and also it is really causing me and my toddler so much stress whenever it is her naptime. I really cannot stay with her for, however long it may take to get to sleep, by patting etc as my toddler needs attention too. What do I do if she misses her naps? She also used to sleep during lunchtime but over the last 2 days does not and wakes after 45 minutes or so!

She did used to settle (at around 2-3 weeks) after allowing her to cry for 15 minutes or so, but has not since. I know that it is also because she is becoming more alert, but what can I do?

Her naps have been very irregular so it is hard to plot the times; she was doing 5.5-6 hrs during the day but now it is more like 3.5-4 hrs and during the night she wakes every 3 hours for a feed but during the day; she used to have to be woken. Over the last 2 days she is not napping well and wakes well before her awakening time – if she settles at all!

At this age your daughter is probably in the middle of her six-week growth spurt and so waking through hunger. This could also be the reason for her not settling so well. As you are totally breast feeding and have another small child as well your supply may just not be meeting her demand at present. It is never easy to rest during the day with two small children. Use expressing to help boost your supply and if possible consider offering one feed [10pm?] as a bottle of expressed milk, which could perhaps be given by someone else so you are able to express and go to bed early to help you cope through the night. See how much you express at 9pm and also first thing in the morning to see how good your supply is. By the end of the day it may well be low and your daughter should always be offered a top up at 6.15pm to help her settle for the evening. At her weight she should be taking about 3-3.5oz feeds.

Teaching a young baby to settle to sleep can take both consistency and persistence. She may be fighting sleep through overtiredness so begin having a wind-down period before each nap 15 minutes earlier than you think she can manage to stay awake i.e. 1 hr 15 minutes after waking. Take both children to her room and settle your toddler with a special toy or “busy bag” near the door which is kept ajar. This bag is kept for the times when you need to spend time with the baby. Fill it with a variety of small toys and surprises and change them regularly so there is always something to interest the toddler. Swaddle your daughter so she is less likely to jerk herself awake with her Moro reflex whilst settling and hold her close but with no eye contact. This is best done by holding her over your shoulder. She may need holding like this for 10 minutes or more but you are teaching her how to calm herself so she can settle to sleep. She needs to learn how to go from being awake and alert, to falling asleep and it can take time for a baby to learn. If she is overtired she will just continue to fight sleep. You will also get up any wind which may bother her once lying down. Once you feel that she is relaxed, and has become “heavy” on you although not totally asleep put her in her cot. To begin with, put her down when her eyes are really heavy with sleep and gradually work towards putting her down more awake. Secure her with a cotton sheet placed lengthways across her and tucked well in on both sides with rolled up towels pushed down the sides of the cot spars. Leave her for 5-10 minutes to settle herself. If she becomes more upset ,rather than beginning to “cry down”, then pick her up to reassure her, calm her and offer her more to eat as hunger is one of the main causes of a young baby being unable to settle. Re-settle and leave her again for 5-10 minutes; if she continues to cry then you must repeat the procedure. For a few days it may take several times of doing this – not feeding to sleep, before she learns how to settle alone. The time you take over this now and the small amount of crying you may have to cope with will pay off as she will learn to settle herself with a small amount of fussing in a few weeks. Many babies do fuss and cry for 5-10 minutes before going to sleep. Escalating in crying is more likely caused by either hunger or wind so both are checked for when you pick her up to reassure her. Having a toddler with you will not make this always easy to carry out but it is worth trying as much as you can at every naptime and in the evening.

It is not unusual for a totally breast-fed baby to need a feed at 2am and another between 5/6am. The fact that she is uncomfortable between these times points to her again not being totally full and also possibly suffering from wind. Once you are sure that your supply is enough for her, then look at wind. Often babies are sleepy at these night feeds and may not latch on so well, thus taking in more wind. Because of their sleepiness they may find it harder to burp after finishing. If she is really unsettled pick her up and see if wind is a problem. You may find it helpful to elevate the head end of her cot by placing two thick telephone directories or books underneath the legs so she is not sleeping totally horizontally , which can be uncomfortable for some babies. Again, check that she is totally swaddled and well tucked in.

In the day, until she learns to settle herself better, adjust her nap times by putting her down 15 minutes earlier at the next one so she does not become overtired. As she learns to settle and sleep better you will be able to move these on, until she is nearer to following the times laid out for her age.

Sleeping FAQ: 0-8 weeks – Night Waking

Since moving into his cot my 7 week old is waking more in the night

Since moving my 7-week-old baby from his moses basket into his cot he has started to wake up more in the night. He used to take a 4-5oz feed at 11pm, then sleep until nearer 3am, take couple of ounces and then settle well and sleep till until 7am. But now after his 11pm he can wake any time between 1am and 3am. I am confident that he is not hungry, and try not to feed him before 3am. But I often spend from 1am till 2.30/3am going to him, rubbing his tummy or putting his dummy in to get him back to sleep. At 3am he will then take between 2-4 ounces then wake again at 5am. Once again I go to him, put his dummy in then eventually give up at 6am and take him downstairs for his first feed. I am exhausted trying to cope with this as I have a 4-year-old as well so the daytime nap timings are not easy to put in place.

He naps at 8.30-10am, 12-2.15pm, 4-5pm.

He takes 4-5ozs at 7am, 4-5ozs at 10.30am, 3-5ozs at 2.30pm, 2-3ozs at 5.15pm, 3-4ozs at 6.30pm, 4-5ozs at 11pm and 2-3ozs at 2.30/3am. He weighs 11lbs 13ozs.

With a baby under six months of age the Moro reflex can still be very strong, and when they come into a light sleep they can often waken fully and find it difficult to settle back to sleep if they have kicked their covers off. If you use a 0.5-tog sleeping bag, this will enable you to also use a thin top cotton sheet to tuck him in well and prevent him thrashing around, without causing concern that he could overheat. Place the cotton sheet lengthways across the cot, and tuck at least six inches of the sheet well under the mattress, then push a rolled up towel down either side, between the mattress and the spars of the cot.

It would also be advisable to look at the amount of daytime sleep your son is having. Because his nights have become very unsettled he probably is needing more sleep during the day than recommended for his age. A vicious circle can soon evolve if this is allowed to continue. Rather than letting him sleep until 11pm in the evening, we would suggest that you begin to wake him at 10pm. As soon as he is well awake offer him a 3-4 oz bottle. Then let him have a period 20-30 minutes of quiet play under his baby gym.. This can be in a room which is quite light and has some background noise. Between 11/11.15pm you should take him to his room, change his nappy and then offer him as much as he will take of a fresh 2-3oz bottle of milk. Ensure that he is burped and tucked in really well following the instructions above. By having him awake longer at the last feed, and offering him a split feed, he should start to sleep longer and more soundly in the night. When he does wake in the night it is important that you offer him a big enough feed so that he settles back to sleep quickly, and sleeps through until 7am in the morning. It is pointless cutting back his middle-of-the-night feed if it results in him being more unsettled in the night and needing to sleep more during the day. Once he goes back to sleeping longer and better in the night, you should aim to gradually reduce the amount of sleep that he is having at his morning nap. Try keeping him awake five minutes longer every few days until he is going down nearer 9am. Once a shorter nap is established at 9am, you can gradually cut back the late afternoon nap. Once he is taking a shorter nap in the morning and later afternoon, you should be able to cut back the time he is awake at 10pm. Again do this gradually reducing the time he is awake by five to ten minutes every few nights, so that he continues to sleep well throughout the night.

Finally, do remember to keep increasing your baby’s feeds during the day. Once he is regularly draining his bottles it would be advisable to increase the amount you offer him by an extra ounce. Check the CLB book for details of which feeds to increase first. If you are unsure as to exactly how much your baby needs to drink for his age and weight you should discuss this with your health visitor or GP.

Sleeping FAQ: 0-8 weeks – Night Waking

Q. My six-week-old twin boys, who were born three and a half weeks early, have put on weight well, but can be quite sleepy by day. This seems to be affecting their nights. They are still waking twice in the night around 2am and 5am. The amount taken at 2am can vary between 2-4ozs. When they wake at 5am and again at 7am they are never very hungry. We also find that they take a large feed at 5/6.15pm, which means that the 10pm feed can be quite small.

I have tried two ways to deal with the 5am waking: the first way is to try to settle them with a dummy without feeding them, which takes some time; the other way is to split the feed between 5am and 7am.  Neither approach seems to improve their interest in feeding at 7am. During the day they are very slow to feed, sometimes taking up to an hour each.

A. To help the twins sleep for one long stretch in the night, it is important that they take a take a good 10pm feed. To ensure that this happens, give them the larger part of their split 5/6.15pm feed at 5pm, and a smaller feed at 6.15pm. Begin to wake them at 9.45pm and ensure they are well awake before you start to feed them. Take them into a well-lit room with gentle background noise. Once they have taken as much milk as they want, let them have a quiet kick until 11/11.15pm. Change their nappies and offer them a top-up feed before settling them back to sleep.

If the twins have fed well at 10/11.15pm, they should be able to get to 2.30/3am before they need their next feed. Although it can be tempting to feed and settle them quickly at this time, it is better to spend some time ensuring they are properly awake, so that they will take a full feed and will hopefully go through to nearer 6/7am in the morning.

Even if the twins are still swaddled, make sure they are tucked in well at night as kicking the covers off is another reason, apart from hunger, that tiny babies tend to wake up earlier in the night. Use a cotton sheet spread lengthways across them and tuck at least six inches each side under the mattress. Secure the sheet by rolling up two hand towels and tucking them down between the spars of the cot and the mattress.

As your babies were early, you may find that they need more sleep than the routines recommend.  Do not be in a hurry to push them on to the next routine, as this could lead to overtiredness, which will create another set of problems.   Try to aim for getting the babies sleeping until between 2/3am, then feeding well and settling them back until 6/7am. By taking one step at a time and not attempting to push them too quickly, they will be much more likely to start to sleep longer at night naturally.