Your baby sleep questions answered with doula Sarah Ockwell-Smith

by motherandbaby |
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Sleep expert Sarah Ockwell-Smith answers your questions about baby sleep.

Sarah is a mum of four, a doula, antenatal teacher and psychology graduate. She is the author of BabyCalm, ToddlerCalm and The Gentle Sleep Book. Sarah specialises in the psychology and science of parenting, ‘gentle parenting’ and attachment theory.

Q: I am struggling with my 14-month-old baby, as he hasn’t settled into a good sleeping pattern. He goes to bed at the same time each day and has a routine. It’s just we have to put him to bed on a bottle or when he’s already asleep – he can’t settle by himself. He’s been teething and had reflux so sleeps next to us in a cot. It it a good idea to start sleep training or controlled crying?

Sarah: Contrary to popular belief, 14-month-old babies can't self settle – this is a very mature skill that requires sophisticated brain development. I am really not a fan of controlled crying (or other similar sleep training methods) it's not meeting your son's needs and could damage his ability to really self settle when he's older.

This is even more pertinent as he's been poorly. I would look into improving his bedtime routine (it should be around an hour), add in some more things to comfort him – smells, music, comfort objects – and make sure you don't miss his early tired signs. I would also look into allergies that have developed because of the reflux, as this may well be part of the problem that you haven’t discovered yet.

Q: My 11 month old has a lot of very serious food allergies but even from birth she was quite a good sleeper. At 11 weeks when her dairy allergy was sorted out she started sleeping from 11pm-8am and since then she has gradually slept from 8/9pm-7.30am.

Then last month she has started refusing to go to bed and screaming for hours. She’s also started waking up screaming at random times in the middle of the night and all she wants is cuddles and to sleep in bed with us. She has never co-slept with us and never been nursed and the only change is she can stand up in her cot. I don't know how to combat it and I'm absolutely exhausted as I’m also three months pregnant. I thought it might be teething as we don't have any yet but as soon as she's in our bed she settles.

Sarah: She has separation anxiety – a very normal, healthy developmental stage that shows how fantastically you are doing as a mother. She has what psychologists call a ‘secure attachment’, which is brilliant. What’s important is that you respond to her needs and reassure her as much as possible now. She's basically just realised that you and she aren't connected and that you can leave her – so every time she wakes and you're not there she's terrified that you might not come back. This is why you need to cuddle and reassure her as much as possible now – it’s not the time for any sleep training.

Q: My three month old sleeps fantastically for the first part of the night but wakes at 4am. He wakes again 30-45 minutes later and wakes up fully at around 6am. The trouble with this is that he is waking up tired and is very grouchy, he will fight sleep for about an hour, feed again and then sleep for about 45 minutes, after which his mood is much better. Any advice that would help to get him back to deeper sleep after his 4am wake would be gratefully received. Our room has black-out curtains, and he generally falls asleep on the breast.

Sarah: His sleep cycles are only 45 minutes long at the moment (yours are double that), which is why he's waking every 45 minutes – he basically needs you to comfort him back to sleep. The most common way babies will do this is by feeding – but at only three months he should be having night feeds still.

Read more: How to handle your toddler's sleep tantrums

Q: My son is nearly nine weeks old. He is breastfed on demand and is very clingy. I cannot get him to lie down in his Moses basket at night to sleep. I have tried putting him straight down after winding and I have tried waiting for him to get into a deep sleep. But he'll always wake up when I lay him down.

Sarah: He’s tiny and no wonder he doesn't like being put down. He's just spent nine months tucked up in your uterus – warm, constantly cuddled, with no bright lights or unexpected sounds, he was curled up on his side and now he's expected to sleep flat on his back.

Things that could help:
1. Get a really good baby sling – I'd recommend a soft stretchy wrap (if you're new to babywearing find a local slingmeet group) and carry him during the day – you’ll have two free hands to get on with stuff then!
2. Try some white noise.
3. If you don't want to share a bed then look into swaddling, but you need to do this quickly if you do and only for a couple of weeks (stop at 14 weeks when it becomes unsafe).
4. Have a read up on 'The Fourth Trimester' and mostly – just enjoy this time. Pretty soon he won't want you to hold him as he speeds off crawling and you will miss these wonderful weeks.

Q: I have an eight-month-old daughter who has never been a wonderful sleeper. Up until six months old she was up every two hours for a feed and cuddle and is always very difficult to settle back to sleep. In the past couple of months she has improved and is waking twice a night and settling fairly quickly. For the last couple of weeks, however, she’s been really unsettled and some night will be up for three to four hours, sometimes crying and sometimes just being awake. If we put her down she screams and just wants to be held. Please help!

Sarah: Please be assured that your daughter's behaviour is perfectly normal. We know that nine-month-old babies wake more than six-month-old babies and that they need a lot more help getting back to sleep. She is likely experiencing separation anxiety and perhaps I think a reaction to something you are feeding her. She wakes when you've put her down as she senses you are no longer next to her and due to the separation anxiety it really unsettles her.

Waking for a few hours in the middle of the night is normal – it’s called 'segmented sleep' and it's how pretty much all humans slept up until a century or so ago. The difference is as an adult you've overridden your natural tendencies and now sleep to the clock, while your daughter hasn't learned to follow societal rules yet. Sleeping for three to four hour stretches is actually very good for her age.

Q: My five-month-old baby exclusively breastfed and slept through the night from about eight weeks. For the past two months, he has started to wake earlier and we are now up about five times a night and the only way he'll settle is to feed him until he falls asleep. What can I do to help him sleep through again?

Sarah: This is because of a huge developmental change that occurs from roughly four to six months. Everything changes for babies and they need reassurance, especially at night. You don't need to do anything – he will grow out of it.

Q: My baby is 14 weeks old and sleeps for five hours then has a feed and sleeps for another five hours. When I used to put her to bed at 9.30/10pm, I would get between six and eight hours sleep but now I put her down earlier at 8/8.30pm she seems to sleep less. Any advice?

Sarah: Did you know that we tend to put our babies down the earliest in the world in the UK? Babies in Asia have an average bedtime of 10pm (and incidentally they have FAR less sleep concerns than we do!). I think a block of sleep of six to eight hours is really good and likely the best you're going to get at her age. The real key is to watch her for her early tired signs (don't wait until she's crying as that's too late) and follow those. That way you'll get the best bedtime for her.

Q: My seven month old regularly goes to bed at night and wakes after 20 minutes and we have a real struggle to get her back to sleep. We have a bedtime routine and have brought things forward, so we start earlier as we think she has been overtired and have recently introduced a comforter to help. I feed her to sleep but it’s becoming less and less effective. What can we do to try and improve things?

Sarah: You need to have a very solid, consistent relaxing bedtime routine and be mindful of the lighting in all rooms in the evening. Plus if you've recently weaned, I would be really looking at her diet for any potential issues there (sleep often regresses after introducing solids).

Q: My three-month-old baby sleeps well at night. I do feel, however, that she gets incredibly tired during the day because she refuses to nap for longer than 30 minutes at a time. I'd really like to get her into a 'napping routine' but I'm struggling – any ideas?

Sarah: The naps might be the trade off for the super long night. She may be a 30-minute napper. We are slightly obsessed with naps in our society – largely because we think they should be taking naps of one to two hours a couple of times per day, but in reality though I'd say this happens in fewer than 50 per cent of babies.

Q: My 20 month old has always been either breastfed or more recently cuddled to sleep, which I'm happy to continue. However, now when going to bed she will do anything to prolong going to sleep. We have a bedtime routine but not a set time as try and use her cues to indicate bedtime, is there anything else we could do?

Sarah: I would actually have a set start to the bedtime routine at this age – she needs predictability and rhythm to her day. No TV (or other screens) for two hours before bed and no chocolate for dessert after dinner. If you use lighting in her room, change it for a low-watt, dim red light bulb and try using battery operated candles in the bathroom.

I'd suggest starting the bedtime routine at 7pm. Spend this hour bathing and massaging her and then read one story and have a cuddle and feed, this should take around an hour. Aim for her to bed asleep at 8pm.

Q: My four month old had a week of sleeping from 9pm to 6am but has not done so for three weeks now. Now she is back to waking for a feed at 9pm, 1am and 4am. How can I help her get through the night?

Sarah: There is a huge developmental change that happens at this age and lasts around another four to six weeks. Everything in her world is changing and therefore she needs you more for reassurance when she wakes. All four-month-olds actually 'wake' about 15 times every night (their sleep cycles are only 45 minutes long) and before this she was calm enough to start a new sleep cycle without your help, but now she needs your help to calm her down for three out of those 15 cycles. You don't need to do anything, just keep comforting her and it will pass naturally.

Q: My little boy is 10 months old, has just had chicken pox and is teething. He finds it hard to be left in his cot now (as we were going in more often when he was ill to give medicine) and gets upset when we try to leave the room. I’ve read a lot about separation anxiety and have tried shushing him, staying in room until he's calm and sleepy and leaving a muslin that smells of me in cot. Can you help?

Sarah: I think he has separation anxiety because of the chicken pox and his teething troubles. The best thing you can do now is to reassure him as much as possible, pick him up when he cries and stay with him until he falls asleep if you need to. This stage is the key to creating confidence and independence when he's older and is the stage when he really learns how to 'self soothe’. You can't just leave him with the muslin, you really need to condition it – it needs to be between you both every time you cuddle and feed him, he needs to view it as being part of you.

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