Question: My 20 week old son has never slept well at night. He goes to bed at 7pm & sleeps til around 10pm then lightly dozes until morning. He is a big baby so maybe he is hungry, I generally breastfeed him when he wakes, unless it hasn't been long since he last woke & then I try to use the dummy first. The dummy doesnt usually work to settle him at night, he will fall straight to sleep if I pick him up & rock him although he then wakes once I put him down.
He sleeps in his cot which is attached to the side of our bed, I was getting a sore back from picking him up out of his cot so often through the night so it makes it a bit easier to have him next to me. He uses a dummy to fall asleep during the day but we don't give to him at bedtime, if he cries we shh/pat him. We have started weaning him & giving him a bottle of formula at 5pm & 10pm but it has made no difference. We can't have him cry too much at night as he wakes our 2 year old daughter. Hope you can help us!
Heidi's Answer: Hello,
At 20 weeks old, night feedings are still normal and common. Although there are babies who sleep through at this age, they are not the majority.
Yet if your son does wake this often each night it is a good idea to not feed each time. Feeding too frequently quickly results in a habit of waking up, due to a hunger feeling induced by taking small sips often. So indeed he can be hungry, but not every hour.
So what you have been doing, breastfeeding unless it hasn't been long, is a good plan, and I will suggest to structure that further. Keeping him in the crib next to you is also a good idea, it helps make it a little less tiring for you and very importantly it helps keep the awakenings short.
Keeping night awakenings short is most important as it helps improve consistent sleep patterns. That is why it can be better to pick up and hold him to help him settle rather than trying to have him stay in the crib to settle with a longer awake time as a result. At times when sh/patting works well (= more quickly) though, then do that of course. Having him cry it out is not necessary.
Have you tried leaving the dummy out at naps? Does it work? If yes, that can be a great help for the nights as it avoids confusion (sometimes sleeping with dummy, sometimes without ...). If he really needs the dummy for naps, keep it but then decide to consistently not give it at night.
I do not recommend to start using the dummy for nights, at least not until we are sure 'nothing else works'. That's because he may settle more easily, but then wake as soon as he looses the dummy at night – I'm guessing that is also the reason why you are not giving the dummy for nights.
Switching to formula is rarely a solution, as you have unfortunately experienced. On the contrary, switching to formula (even partly) before 6 months old can give rise to digestive problems (due to immaturity of the digestive system) which in turn easily disturbs sleep. Something I hope you have not experienced. I you have, revert to full breastfeeding for at least another month.
Either way, being a big baby and in-between 4-5 months (a typical growth spurt time), it is a good idea to increase his food intake. But that is then better done nicely spread out through the day, not just in the evening hours.
Take a moment to see if you can easily increase his intake a bit. You can do that by insisting a bit more at each breastfeed. Ensure he 'empties' the first breast completely before starting the other one. If he stops, burp if necessary and maybe change him, then see if he wants some 'dessert'. Or could you squeeze in a feed in his daily schedule?
Not only will it give him some more reserves for the night, it will increase milk production too, with the same effect on nights.
In all this, do be careful not to 'stuff' him. We are talking about a careful, gentle increase where possible. But forcing or stressing about it is not necessary.
Then for nights, as long as you have the feeling that he may be hungry, do feed once or twice each night. But try to be consistent. Such as, you feed when he wakes around 10pm. Then the first next feed will be the first awakening after 1am. The next feed will be at least 3 hours later then this one. (3 hours is average, adapt to 2 or 4 hours if that feels better).
At the other awakenings, help him settle and go back to sleep as quickly as possible, using one of 3 options (choose option 2 if option 1 does not work, choose option 3 if option 2 does not work):
1. Wait a few moments before you go to him. He may just fuss a bit and then go back. Even just hearing you walking about the corridor may be enough reassurance. Going in too early may wake him up completely whereas he may only be 'turning around' to go back to sleep. Do go to him before he does wake up completely or gets upset though.
2. Sh/pat him while he's in the crib until he sleeps nicely.
3. Pick him up and hold/rock him until he sleeps. You say he wakes when you put him down, but than can simply mean you need to hold him longer, until he's in a deep sleep. This can take 20-30 minutes after first dozing off.
At these no-feeding awakenings it can be a great help if your partner can help him settle then. It's easier to deny nursing for him, and your son will not smell the milk ... Each awakening should be in the dimmest possible night light, with very little interaction, ... just keep those awakenings as boring as possible.
I suggest you do this for a good several weeks, including the gently increased food intake and the schedule ideas I suggest below. During these weeks, you will be working on consistency, clarity about nursing once or twice but not every time, short awakenings, ...
Then later on you can work with the gentle self soothing method to gradually wean from the habit of holding until he sleeps. Or use the adapted method to wean from sh/patting, staying near her or having her crib in your bed.
Then lastly about his sleep schedule: you do not mention how often or regularly he naps. 2 or 3 regular naps are typical right now. Having those consistent, regular naps helps improve sleep at night.
In case you are looking for ways to set up a well-fitting nap routine, you may find my "Nap in a Snap!" guide helpful.
If you have a good nap routine, that is perfect. You can then experiment a little with the timings. Observe your son closely and if there is any sign of over-tiredness at nap or night time bedtime, shift that time to a bit earlier (15-30 minutes). Small changes like that can drastically improve his sleep patterns. If he's really not tired at all, work in the opposite direction (but remember that being over-active is a typical sign of over-tiredness so it's easy to confuse those).