Katie’s 5 month old daughter Ella has begun to wake several times a night and will only settle with a feed, despite being a good sleeper previously.
On the first night, she woke frequently and needed a lot of reassuring to get back to sleep. My job is to get her into the sleep habits which are appropriate for her age, weight and development, so she can build on those over the coming weeks until she sleeps through the night.
I arrive for my second night with Katie at 9pm and have time to discuss how Ella has behaved during the day.
“She seemed quite calm actually, given how broken her night was last night. She went down for her morning nap like a dream and slept through beautifully; I was amazed,” Katie tells me. “But then this afternoon she simply wouldn’t settle, despite the fact that she was obviously exhausted. She could hardly keep her eyes open. Why is it that babies who are so obviously desperate to go to sleep, simply can’t seem to drop off?”
I explain how a baby’s sleep pattern can be like a jigsaw puzzle. “It all looks pretty good, but there is one piece which doesn’t fit into the one hole which is left. And in order to make that piece fit, you actually have to mess up the picture and rearrange it before you get the whole picture with every piece where it should be.”
What this means is that when you undertake sleep training, even with a 5 month old where you are not expecting to teach her to sleep for 12 hours through the night but just to learn better, more age-appropriate sleep habits, things may seem to be getting worse before they get better.
“So I spent ages settling her for her afternoon nap, and she finally fell asleep just as it was time for her to wake up! I wasn’t sure what to do, whether to leave her to sleep or to wake her up.” Katie’s face is a picture of worry and concern, so I reassure her and tell her she could have phoned me.
“I know,” replies Katie, “but I wanted to feel in control of it myself – and I just don’t.”
We talk for a while longer. I explain to Katie that we are trying to fit Ella’s sleep habits into her routine of eating and playing, so we have given ourselves a framework within which to work. We had agreed that Ella needs to wake up at 7am, which is 12 hours after she has been put down for the night. We had put in the appropriate times for her feeds, which were at more or less the same time as breakfast, lunch, tea and supper. In between those times we had put her nap times.
As we map out Ella’s day on a sheet of paper at the back of the Sleep Diary, Katie’s face becomes calmer and clearer. “I am beginning to understand better,” she says. “Even if it takes the whole of her nap time to fall asleep, I can’t let Katie sleep beyond the end of her normal nap time because everything else gets knocked out of place – all the other pieces of the jigsaw puzzle won’t fit! Is that right?”
“That’s exactly right”, I tell her. I also point out that although Ella is only 5 months old, her main feeds correspond – and have always corresponded – to a child’s meal times. The concept of feeding every four hours is often perceived to be a bit of a bind, something that interrupts the normal activities of the day. But it is only the night feeds that differentiate a baby from her older sibling. If a new parent can adapt her baby’s feeding routine to coincide with the rest of the family’s breakfast, lunch, tea and supper times, she will find there is time to do other things in between and that the process of weaning is simplified significantly.
“Wow, thank you,” beams Katie. “It isn’t actually rocket science, but I am so tired I just needed someone to point it out to me.”
I make a cup of tea and bid her goodnight. I look in on Ella as I pass her bedroom, go to my own room and make notes on our conversation. It is something I always do, so that Katie can look back on the conversation and remember the salient points whenever she might need to.
At 11pm I go into Ella’s room with a bottle of milk I have just prepared. I wake her gently; she looks so peaceful it seems a shame to do so, but I know that we both need to keep to the appropriate timetable so that Ella has a structure to build on herself. She takes a short while to focus on me, and I can almost see her working out where she has seen me before. I keep the light off, but the light on the landing is sufficient for us to see each other, and of course Ella is using other senses to work out who I am. As I lift her out of her cot she settles into the crook of my arm and nuzzles for the bottle.
Ella feeds effectively and easily. Her sleep disruption is certainly not due to hunger; Katie and I have made sure of that. Katie understands that a normal, healthy baby will rarely feed effectively for more than about 45 minutes; they simply don’t have the energy to do so, and you will see the force of their suck wane as they run out of energy and interest, and as their little tummies become full.
At the end of the feed, I make sure that Ella is properly winded and I use this as an opportunity to make sure she is awake as I put her back into her cot to say, “night, night, see you in the morning.” Ella needs to learn that she can fall asleep by herself, and that it is all right to do so. Therefore, tempting though it may be to allow her to fall asleep on my shoulder as I finish winding her, I know I need to wake her up sufficiently so that she is conscious that I have left her. She will fall asleep again almost immediately, because she is tired and full up, but she is cognisant that I have gone.
I often try to make parents understand this from a baby’s point of view by explaining that, if you fell asleep on the sofa after a good supper with friends and then found yourself in your bed a few hours later, you would worry about how you got there and where your friends had gone. So if you put your baby into her cot asleep and leave her, when she wakes up at the end of a sleep cycle she will be confused, worried and wonder where you have gone. This is why she will cry.
At the door I turn to see Ella’s eyes are indeed fluttering closed and she gives a contented sigh as I leave her to sleep.
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