Clinical Reference Systems: Pediatric Advisor 10.0
Night Awakenings From Holding Until Asleep
(Trained Night Crier)
- Your child is over 4 months old and wakes up and cries
one or more times a night.
- The crying occurs most nights.
- Your child is held, rocked, or walked until asleep.
- Your child doesn't need to be fed in the middle of the
night. (Until the age of 2 or 3 months, most babies need
to be fed during the night.)
- Your child has awakened and cried at night since birth.
- The child's parents are tired, but the child is not.
- Holding or rocking your baby until asleep.
All children normally wake up four or five times each
night after dreams. Because they usually do not wake up
fully at these times, most children can get back to
sleep by themselves. However, children who have not
learned how to comfort and quiet themselves cry for a
parent. If your custom at naps and bedtime is to hold,
rock, or lie down with your baby until asleep, your
child will not learn how to go back to sleep without
your help. Babies who are not usually placed in their
cribs while they are still awake expect their mothers to
help them go back to sleep when they wake up at night.
Because they usually fall asleep away from their cribs,
they don't learn to associate the crib and mattress with
sleep. This is called poor sleep-onset association.
- Providing entertainment during the night.
Children may awaken and cry more frequently if they
realize they gain from it; for example, if they are
walked, rocked, or played with, or enjoy other lengthy
contact with their parents. Being brought to the
parents' bed makes the problem far worse. Trained night
crying can also begin after situations that required the
parents to give more nighttime attention to their baby
for a while. Examples of such problems are colds,
discomfort during hot summer nights, or traveling. Many
babies quickly settle back into their previous sleep
patterns after such situations. However, some enjoy the
nighttime contact so much that they begin to demand it.
- Believing any crying is harmful.
All young children cry when confronted with a change in
their schedule or environment (called normal protest
crying). Crying is their only way to communicate before
they are able to talk. Crying for brief periods is not
physically or psychologically harmful. The thousands of
hours of attention and affection you have given your
child will easily offset any unhappiness that may result
from changing a bad sleep pattern.
If you try the following recommendations, your child's
behavior will probably improve in 2 weeks. The older your
child is, the harder it will be to change your child's
habits. Children over 1 year old will fight sleep even when
they are tired. They will vigorously protest any change and
may cry for hours. However, if you don't take these steps,
your child won't start sleeping through the night until 3 or
4 years of age, when busy daytime schedules finally exhaust
HELPING A TRAINED NIGHT CRIER
- Place your baby in the crib drowsy but awake for naps
It's good to hold babies and to provide pleasant bedtime
rituals. However, when your baby starts to look drowsy,
place him in the crib. Your child's last waking memory
needs to be of the crib and mattress, not of you. If
your baby is very fussy, rock him until he settles down
or is almost asleep, but stop before he's fully asleep.
He needs to learn to put himself to sleep. Your baby
needs to develop this skill so he can put himself back
to sleep when he normally wakes up at night.
- If your baby is crying at bedtime or naptime, visit your
baby briefly every 5 to 15 minutes.
Visit your baby before she becomes too upset. You may
need to check younger or more sensitive babies every 5
minutes. You be the judge. Gradually lengthen the time
between your visits. Babies cannot learn how to comfort
themselves without some crying. This crying is not
- Make the visits brief and boring but supportive.
Don't stay in your child's room longer than 1 minute.
Don't turn on the lights. Keep the visit supportive and
reassuring. Act sleepy. Whisper, "Shhh, everyone's
sleeping." Add something positive, such as "You're a
wonderful baby," or "You're almost asleep." Never show
your anger or punish your baby during these visits. If
you hug him, he probably won't let go. Touch your baby
gently and help him find his security object, such as a
doll, stuffed animal, or blanket.
- Do not remove your child from the crib.
Do not rock or play with your baby or bring her to your
bed. Brief contact will not reward your baby enough for
her to want to continue the behavior. Most young babies
cry 30 to 90 minutes and then fall asleep.
- For crying during the middle of the night, temporarily
hold your baby until he is asleep.
Until your child learns how to put himself to sleep at
naps and bedtime, make the middle-of-the-night
awakenings as easy as possible for everyone. If he
doesn't fuss for more than 5 or 10 minutes, respond as
you do at bedtime. Otherwise, take your crying child
out of the crib and hold him until he is asleep. Don't
turn on the lights or take him out of the room. Try not
to talk to him very much. Often this goes better if Dad
- Help your child attach to a security object.
A security (transitional) object is something that helps
a waking child go to sleep. It comforts your child and
helps your child separate from you. A cuddly stuffed
animal, doll, other soft toy, or blanket can be a good
security object. Sometimes covering a stuffed animal
with one of the mother's T-shirts helps a child accept
it. Include the security object whenever you cuddle or
rock your child during the day. Also include it in your
ritual before bedtime by weaving it into your
storytelling. Tuck it into the crib next to your child.
Eventually, your child will hold and cuddle the stuffed
animal or doll at bedtime in place of you.
- Later, phase out the nighttime holding.
Phase out nighttime holding only after your child has
learned to quiet herself and put herself to sleep for
naps and at bedtime. Then you can expect her to put
herself back to sleep during normal middle-of-the-night
awakenings. Go to her every 15 minutes while she is
crying, but make your visits brief and boring. After
your child learns to put herself to sleep at bedtime,
awakening with crying usually stops in a few nights.
- Other helpful hints for sleep problems.
- Move the crib to another room.
If the crib is in your bedroom, move it to a separate
room. If this is impossible, cover one of the side
rails with a blanket so your baby can't see you when
he wakes up.
- Avoid long naps during the day.
If your baby has napped for more than 2 hours, wake
her up. If she has the habit of taking three naps
during the day, try to change her habit to two naps
- Don't change wet diapers during the night.
Change the diaper only if it is soiled or you are
treating a bad diaper rash. If you must change your
child's diaper, use as little light as possible (for
example, a flashlight), do it quickly, and don't
provide any entertainment. If your child is standing
up in the crib at bedtime, you can leave him in that
position. Try to get your child to settle down and
lie down. If he refuses or pulls himself back up,
leave him that way. He can lie down without your
help. Encouraging your child to lie down can soon
become a game.
- Keep a sleep diary.
Keep a record of when your baby is awake and asleep.
Bring it with you to your office follow-up visit.
CALL YOUR CHILD'S PHYSICIAN DURING REGULAR HOURS IF:
- You think the crying has a physical cause.
- Your child acts fearful.
- Someone in your family cannot tolerate the crying.
- The steps outlined here do not improve your child's
sleeping habits within 2 weeks.
- You have other questions or concerns.