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| |    Waking in the Night by Dr. Benjamin Spock reviewed by Robert Needlman, M.D., F.A.A.P. Some babies go to sleep like angels, but develop the habit of waking in the middle of the night, usually in the second half of the first year or early in the second year. Sometimes this starts with teething or an ear infection that wakes them with pain. When the doctor makes the diagnosis, the parents may feel guilty that they hadn't suspected pain or a physical illness. Then, when the baby stirs and whimpers on succeeding nights, they hurry in apprehensively to comfort him, though it's actually very unlikely that the pain has recurred. 2 a.m. party? I suspect the baby catches some of their anxiety and, in addition, enjoys all this activity in the middle of the night. All babies, like older people, partially wake up a number of times each night, when they are in the light sleep stage, and shift position. When they have been picked up and treated to company and a snack for several nights, I imagine they learn to rouse themselves from half awake to wide awake to have more fun. In a few cases, a baby may come to wake not just once but several times, to stay awake longer and longer each time, to demand not just company but to be walked, and to resist being put back to bed by crying furiously. Many otherwise healthy babies go through periods of night waking, usually around 8 to 10 months of age. They have just learned that things still exist even when out of sight. When they wake up in the night, they now know that their parents must be nearby, so they call for them. The problem often goes away when the child begins to walk, then reappears around 18 months, as problems of separation normally become a bit worse. Not all babies go through these phases, but many do. Sometimes the problem arises because the baby has never learned how to fall asleep on his own. Babies can become dependant on being held, sung to, rocked, nursed, given a bottle, or even driven in a car in order to fall asleep. When a parent always holds or rocks the baby until he is completely asleep, rather than putting him down in the crib when he is drowsy but still a little bit awake, the baby develops a habit of having to be in a parent's arms before he can fall asleep. Sleep experts call this a sleep-onset association: The baby associates the feeling of being held with the process of falling to sleep. Without the holding, he simply can't fall asleep. If you give your baby a bottle to fall asleep with, he may come to rely on that as a sleep-onset association. You may find yourself fixing bottles two or three times a night. Preventing night waking It's easy to prevent a lot of night-waking problems if you start when your baby is very young. By three or four months, make it a habit to put your baby down to sleep when he is drowsy but not yet fully asleep. That way, he won't develop a habit of having to be held by you each time he wakes in the middle of the night. How to stop night waking Most cases can be cured easily. The baby has to learn that there is nothing to be gained by waking and crying. This can usually be accomplished in two or three nights by letting her cry and not going to her at all. She is apt to cry for 20 or 30 minutes the first night (it may seem like much longer), 10 minutes the second night, not at all the third. One additional requirement is necessary, in my experience. The baby must not see the parents when she wakes up. If she sees them, even if they pretend to be asleep, this angers her and stimulates her to keep up the crying indefinitely. It is essential to put her to bed in a different room from theirs. If this is absolutely impossible, a screen or curtain can be rigged to prevent her from seeing the parents. This approach is a bit stressful for you and your baby, but in the long run may be the easiest, since it tends to solve the problem quickly. You are the best judge of your baby. If you feel comfortable that she is healthy, growing normally, and is not overly anxious as a rule, you might well feel confident that she can handle the stress of being left to soothe herself for a couple of nights. A more gradual approach Some believe that these waking-in-the-night problems between 6 and 18 months are primarily due to separation anxiety and that the best treatment is for the parents to go into the baby's room, sit down beside the crib without turning on the light, and keep murmuring something reassuring such as, "Don't worry, Mommy is right here. Go back to sleep now," until the baby does so. The key is to do less and less every night to comfort the baby. If the first night you lightly stroke the baby, on the second night continue the soothing voice but don't stroke the child. This method usually takes a lot longer than the first one because it takes the child longer to realize she has to get herself to sleep. Certainly if it works, it will be easier on parent and child than letting the child cry for two or three nights. If the baby simply won't go back to sleep this way, or if the waking continues for weeks, you can use the less tenderhearted method.
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