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March 22, 2018

Babies who have been sleeping long stretches through the night often regress to breastfeeding two-hourly at four to six months. Emma Purdue offers advice to get baby back on track... 

Your baby is born very neurologically immature. They don’t know the difference between night and day, so round-the-clock feeding and napping without any decent blocks of night sleep is to be expected. As your newborn moves through those early months, their circadian rhythm develops. Night and day begins to take meaning, and lots of babies start to sleep 6–8 hours in a row at around 3–4 months old. This feels like bliss compared to the broken nights of a newborn, and as parents we breathe a sigh of relief. This is a sleeping pattern we can cope with.

Why does their sleep revert back to waking every two hours through the night? What can we do? 

This is a common situation that it’s almost predictable, especially in those babies who are still cat-napping at 4–6 months. By four months old, your baby's night sleep becomes more organised. They move from awake to REM sleep, then into light non-REM sleep, and further into deep non-REM sleep and back ro awake, every two to four hours. Often your baby will drift from deep sleep into REM, have a brief awakening that you're not aware of, then go back to sleep. Or, they will move to being fully awake and cry out for you at this point. 

If your baby relies on feeding to get from that awake phase back to sleep, every time their sleep cycle enters that awake period, they will cry out for you to feed them back to sleep. This could be as frequently as every 2-4 hours, often more frequently after midnight. As these night-time cycles emerge around 4-6 months old, we can be caught off guard and think our babies are going through a short term growth spurt, so fall into the habit of feeding back to sleep as frequently as every 2 hours. As days go on and we realise that this perhaps, isn't a growth spurt or what started out as a growth spurt is now a habit. 

Frequent overnight feeds can then result in reverse cycling: when a baby takes in more calories overnight than throughout the day. The symptoms are babies not interested in feeding through the day, appearing fussy or distracted at the breast or bottle. We are working towards a feeding balance where most calories are consumed throughout the day and fewer at night. This helps support the body’s circadian rhythm and work towards better, more restorative night sleep by baby’s first birthday. 

If you have become stuck in the situation where you are feeding back to sleep every two hours overnight, it’s important to understand that it’s normal for your baby to wake frequently overnight. The goal is not to change their naturally occurring sleep cycles and phases, but to encourage your baby to get from that awake phase back to their sleeping phases without a feed from Mum. 

Knowing your baby is reverse cycling with these two-hourly feeds helps us to know we can’t drop all these night feeds at once. When we tackle the transition from two-hourly feeding to sleep overnight, we need to make changes gradually and give your baby a chance to increase their calories and feed throughout the day in order to successfully change their night sleep feeding patterns.

What's the strategy? 

Aiming for four-hourly feeds for the first nights gives baby enough time to increase their day feeds, and four hours overnight is not an unrealistic time to go between feeds as long as your baby is thriving and gaining weight. In between these four-hourly feeds, your baby will go through phases of REM sleep, non-REM sleep, and awake. When they reach the awake phase, they will be looking for that feed to get back to sleep. This is because the feed has become a sleep association for your baby. It is here where the change occurs. We need to teach your baby a new way to fall back to sleep, which doesn’t rely on a feed.

This can be done by sitting soothing them with your voice; try shushing or singing. If they are upset, pick them up and give them a cuddle, maybe pat their back. Be patient as they will probably be rooting for that feed to get back to sleep. Once they are calmer, you can put them down and continue to use your voice and gentle touch to help them as they go back to sleep. If they get upset again, repeat the soothing. This might happen several times. Be very patient and calm with your baby. Remember they are used to being fed back to sleep, so this change is not easy for them. After 2–3 days of doing this, you should notice baby is settling faster without a feed. You will need to gradually reduce how much assistance you provide over the coming nights. This will support your baby to learn to put themselves back to sleep without your help.

If you want to change this feeding association quicker, you can try leaving your baby to cry, grizzle or fuss for 5–10 minutes before going in and using your voice to soothe them. Again, I suggest shushing or singing, depending on what your baby likes. Do this for a few minutes, then retreat and give your baby another 5–10 minutes to try and go back to sleep without a feed. Continue with this sequence until baby falls back to sleep. It shouldn’t take more than 45 minutes on average for the first night, and it will become quicker as the days move on.

Gently changing an overnight feed-to-sleep association can take 1–3 weeks to succeed, and letting your baby grizzle or cry might take 7–10 days to fully change baby’s sleep association. Both will work. The best option is simply the one you feel most comfortable with, and that doesn’t compromise your parenting style. Once you have managed to get your baby down to four-hourly feeds throughout the night, they will be taking bigger, longer feeds through the day, and if your baby is showing signs they are not hungry in the morning you can work on dropping down to one night feed. I would only recommend this if your baby is gaining good amounts of weight, is not hungry at 7am, and their naps are going well. You can use the same settling method you used to change your baby’s feed-to-sleep association to drop one of those night feeds.

Why does my baby cry out every two hours at night? 

  • Short naps throughout the day 
  • Over-tiredness 
  • Late bedtimes 
  • Short, distracted daytime feeds 
  • Lack of positive sleep associations 

What can I do to support my baby's night sleep? 

  • Encourage at least one long nap a day 
  • Schedule more frequent naps if they are short (45 mins) 
  • Early bedtimes 
  • Remove distractions and encourage full feeds 
  • Introduce positive sleep associations such as white noise, sleeping bags, swaddles and sleep rituals 

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