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Infant Sleep Patterns

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: My son is 10 months old but still wakes up a minimum of once at nighttime -- we give him six ounces of formula and then he goes back to sleep again. We give him a heavy meal (like rice pudding) before he goes to sleep, but he still seems to get up every night. He also tosses and turns a lot at nighttime. He sleeps for a maximum of one and half hours throughout the daytime. I breast-fed him until he was seven months. Could this be the reason?

Question: My daughter is six months old and so far she hasn't slept one long night. I have tried everything my pediatrician said, but I think she is getting used to waking up twice in the middle of the night. I can't stand it anymore. I could fall asleep anytime during my workday.

A: Most children can sleep six or seven hours at night by three or four months of age, and by six months of age should be sleeping 8 to 12 hours through the night. If your baby was premature or had low birth weight, or has any chronic medical problems, then he might not be able to make it that long without eating. Assuming your babies are healthy and growing appropriately, however, they should be able to go at least eight hours.

As you both have suggested, the babies have become accustomed to waking up and feeding at night, and now you need to change the habit. First of all, if the baby is in the same room as you (and you have enough space), move him out of your bedroom. Some babies will go right back to sleep if they realize that no one is there.

Secondly, make sure that your baby is not falling alseep while he is being fed. Babies get conditioned to their enviornment when they are falling asleep, and when they wake up at night (as all of us do a little bit), they need the same environment (being fed) in order to go back to sleep. You should give him a reasonable feeding in the evening, but put him in the crib while he is still awake.

Once you have done these two things, you can cut back the amount of food that he gets during these night wakings, thus stimulating him to take a little more during the day to make up the difference in calories. So for the ten-month-old, put four instead of six ounces in the bottle for two or three days. Then go to just two ounces for a couple of days. Finally, see if he will go back to sleep on his own if you let him fuss a little longer.

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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.


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