Clinical Reference Systems: Pediatric Advisor 10.0
Night Awakenings from Feeding until Asleep
(Trained Night Feeder)
- Your child is over 4 months old and wakes up and cries
one or more times at night to be fed.
- Your child wakes up to be fed most nights.
- Your child is bottle-fed or breast-fed until asleep.
- Your child has awakened to be fed at night since birth.
- The child's parents are tired, but the child is not.
Note: From birth to the age of 2 months, most babies awaken
twice each night for feedings. Between the ages of 2 and 3
months, most babies need one feeding in the middle of the
night. By 4 months of age, most bottle-fed babies sleep more
than 7 hours without feeding. Most breast-fed babies can
sleep through the night by 5 months of age. Normal children
of this age do not need calories during the night to stay
- Nursing or bottle-feeding the baby until asleep. If the
last memory before sleep is sucking the breast or
bottle, the bottle or breast becomes the baby's security
object. The child does not learn to comfort himself and
fall asleep without the breast or bottle. Therefore,
when the child normally wakes up at night, the child has
the habit of not being able to go back to sleep without
feeding. Being brought to the parents' bed for a
feeding makes the problem far worse.
- Leaving a bottle in the bed. Periodically during the
night the child sucks on a bottle. When it becomes
empty, the child awakens fully and cries for a refill.
Bottles in bed, unless they contain only water, also can
lead to severe tooth decay.
- Feeding often during the day. Some mothers misinterpret
"demand feedings" to mean that they should feed the baby
every time he cries. This misunderstanding can lead to
feeding the baby every 30 to 60 minutes. The baby
becomes used to being fed small amounts often instead of
waiting at least 2 hours between feedings at birth and
at least 4 hours between feedings at the age of 4
months. A pattern of feeding every hour or so is called
grazing. This problem occurs more often in breast-fed
babies if nursing is used as a pacifier. Bottle
dependency leads to the bad habit of carrying a bottle
around during the day. Also, giving a child a lot of
liquid at night means your child will wake up more often
because his diapers are soaked.
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 FEEDER
- Gradually lengthen the time between daytime feedings to
3 or 4 hours. You can't lengthen the time between
nighttime feedings if the time between daytime feedings
is short. If a baby is used to frequent feedings during
the day, he will get hungry during the night. Grazing
often happens to mothers who don't separate holding from
nursing. For every time you nurse your baby, there
should be four or five times that you snuggle your baby
without nursing. Gradually postpone daytime feeding
times until they are more normal for your baby's age.
If you currently feed your baby hourly, increase the
time between feedings to 1 and 1/2 hours. When your
baby accepts the new schedule, go to 2 hours between
feedings. When your baby cries, cuddle him or give him
a pacifier. Your goal for a formula-fed baby is to give
him 4 bottles a day by 4 months of age. Breast-fed
babies often need five feedings each day until they are
6 months old, when solid foods are added to their diet.
If your child is over 6 months old, also introduce cup
- At naps and bedtime, place your baby in the crib drowsy
but awake. When your baby starts to act sleepy, place
her in the crib. If your baby is very fussy, rock her
until she settles down or is almost asleep, but stop
before she's fully asleep. If your baby falls asleep at
the breast or bottle, it is best to wake her up. To
help your baby not think of feeding at bedtime, consider
feeding her 1 hour before bedtime or before a nap. Your
baby's last waking memory needs to be of the crib and
mattress, not of the breast or bottle. She needs to
learn to put herself to sleep. Your baby needs to
develop this skill so she can put herself to sleep when
she 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 he becomes too upset. You may need to check
babies younger than 1 year or more sensitive babies
every 5 minutes. Gradually lengthen the time between
your visits. Make your visits brief and boring but
supportive. Don't stay in the room longer than 1
minute. Don't turn on the lights. Act sleepy.
Whisper, "Shhh, everyone's sleeping." Do not remove
your child from the crib. Do not feed, rock, or play
with your baby, or bring him to your bed. This brief
contact will not reward your baby enough for him to want
to continue the behavior.
- For crying during the middle of the night, temporarily
hold your baby until asleep. Until your child learns
how to put herself to sleep at naps and bedtime, make
the middle-of-the-night awakenings as easy as possible.
If she 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 her until asleep.
However, don't turn on the lights or take her out of the
room. Try not to talk to her very much. Often this
goes better if Dad goes in.
After the last feeding of the day at 9 to 10 PM, feed
your baby only once during the night. Provide this
nighttime feeding only if 4 or more hours have passed
since the last feeding. Make this nighttime feeding
boring and brief (no longer than 20 minutes). Stop it
before your child falls asleep, and replace it with
- Stop giving your baby any bottle in bed. If you feed
your child at bedtime, don't let him hold the bottle.
Also feed your child in a different room than the
bedroom. Try to separate mealtime and bedtime. If your
baby needs to suck on something to help him go to sleep,
offer a pacifier or help him find his thumb.
- 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 feeding. Phase out the
nighttime feeding only after the time between daytime
feedings is more than 3 hours AND your child can put
herself to sleep without feeding or rocking. Gradually
reduce the amount you feed your baby at night. Decrease
the amount of formula you give a bottle-fed baby by 1
ounce every two to three nights. Nurse a breast-fed
baby on just one side and reduce the time by 2 minutes
every two to three nights. After 1 to 2 weeks, your
baby will no longer crave food at night and should be
able to go back to sleep without holding or rocking.
- 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 the 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 soon becomes a
- Keep a sleep diary. Write down the times when your baby
is awake and asleep. Bring this record with you to your
office follow-up visit.
CALL YOUR CHILD'S PHYSICIAN DURING REGULAR HOURS IF:
- Your child is not gaining enough weight.
- 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.