Approximately 10% to 15% of children between 4 months and 24 months of age have problems sleeping through the night. They wake up and cry one or more times during the night in order to be fed or entertained by their parents. These interruptions usually occur every night. In most instances, the child has behaved this way since birth. If your child fits this description, the information presented here will help you understand the problem and take steps to establish a normal nighttime sleeping pattern.

All children have 4 or 5 partial awakenings each night after dreams. Most can put themselves back to sleep. Children who have not learned self-comforting and self-quieting skills cry for a parent. If your custom at naps and bedtime is to rock or feed your child until asleep, your infant will not learn how to go back to sleep without your help.

Trained Night Feeders
If your child is over 4 months of age and wants to be fed during the night, deal with this problem first. From birth to 2 months of age, most babies normally awaken twice a night for feedings. Between 2 and 3 months, most need one middle-of-the-night feeding. By 4 months of age, about 90% of infants sleep more than 8 consecutive hours without feeding. Normal children of this age do not need any calories during the night to remain healthy. The other 10% can learn to sleep through the night if you take the following steps:

• Lengthen the time between daytime feedings to 4 hours or more. Nighttime feeding intervals cannot be extended if the daytime intervals are short. If a baby's stomach is conditioned to expect frequent feedings, he will have hunger pangs during the night. Gradually postpone daytime feeding times until they are more normal for child's age. Your goal for formula-fed babies is 4 meals each day by 4 months of age. (Breast-fed babies often need 5 feedings each day until baby foods are introduced). During the day, your infant's demands for unnecessary feedings can be answered with extra holding, attention, or a pacifier.
• Place your baby in the crib drowsy, but awake. When your baby starts to act drowsy, stop feeding him and place him in the crib. His last waking memory needs to be of the crib, not of the breast or bottle. He needs to learn to put himself to sleep. He will need this self-quieting skill during normal awakenings at night. This change will require some crying. If your baby falls asleep while feeding, it is best to awaken him before placing him into the crib. For crying, go to your child every 15 minutes, but don't feed him or lift him out of the crib. Give him a hug and leave. Stay for less than a minute. Help him learn to self-initiate sleep at naps and bedtime when you can better tolerate the crying. For middle-of-the-night crying, you can rock him to sleep for now. Sometimes, a teddy bear or favorite blanket can help your baby transition to sleep.
• Discontinue any bottle in bed immediately. If you feed your child at bedtime, don't let her hold the bottle. Also feed her in a different room than the bedroom. Try to separate mealtime and nap times. If your baby needs to suck on something to help her go to sleep, offer a pacifier or help her find a thumb. In addition to promoting sleep problems, leaving a bottle in the crib can lead to a severe form of tooth decay known as 'baby bottle caries'. It can also contribute to ear infections because milk can travel from the throat to the ear through the eustachian tube when the baby drinks lying down.
• Phase out night feedings. For now, after the 10 or 11 pm last feeding of the day, only feed your baby once during the night and make it both brief and boring. For other awakenings at night, rock your child to sleep. After the daytime feeding intervals are normal, start to gradually reduce the amount you feed your baby at night. For bottle-fed babies, the amount of formula you give can be decreased by one ounce every few nights until your infant no longer has a craving for food at night. Nurse breast-fed babies on just one side and for fewer minutes. If it takes more than 20 minutes, you are handling or burping the baby too much.

• Place your baby in the crib drowsy but awake at naps and bedtime. It's good to hold babies. But when your baby starts to look sleepy, place him in the crib. His last waking memory needs to be of the crib, not of you. He needs to learn to put himself to sleep. If your baby is very fussy, rock him until he settles down, but stop before he's fully asleep.
• For crying, make brief contact every 15 minutes. Infants cannot learn to self-comfort without some crying. This crying is not harmful. If the crying continues, visit your baby in the crib every 15 minutes. Don't stay longer than one minute. Act sleepy. Whisper, "Shhh, be quiet, everyone's sleeping." Add a few reassuring comments and give some gentle pats. Do not turn on the lights or remove your child from the crib. Do not rock or play with the baby, bring her to your bed, or stay in the room for more than one minute. Most infants will cry for 30 to 90 minutes and then fall asleep. If the crying persists, you may recheck you baby every 15 minutes, for one minute or less each visit.
• For middle-of-the-night crying, rock your baby to sleep temporarily. Until your child learns how to put himself to sleep, make the middle-of-the-night as easy as possible. Take your crying child out of the crib and rock him to sleep. However, don't talk to him, leave the room or turn on the lights. After he has learned to quiet himself for naps and bedtime, you can place the same demands on him for middle-of-the-night crying. Namely, go to him every 15 minutes - but make your contact brief and boring. By then, this problem can be turned around in a few nights.

• Stay with your child if he is fearful. At bedtime and naptime, put your child in the crib drowsy but awake. Stay as long as it takes to calm him, but don't lift him out of the crib. At the most, sit in a chair next to the crib with your hand on his body. A set of headphones with some good music may help you pass the time. Make a few reassuring comments initially, then don't talk to him. If it's the middle-of-the-night, consider going to sleep in your child's room in a sleeping bag.
• Leave briefly every 15 minutes. Leave for 1 or 2 minutes every now and then to teach your child that separation is tolerable because you do come back. Leave the door open and a nightlight on if your child has separation fears. Provide lots of holding during the day. During the day, respond to your child's fears with lots of hugs and comforting. Young babies may need more time being carried about in a front sling or backpack. Children of mothers working outside the home need extra attention and cuddling in the evenings. Also play separation like peekaboo, hide-and-seek, or chase me. Fears and insecurities can be completely treated during the day.

• You pick the time and place of the battle.  Don't try to do all of these behavior changes when you're stressed out with a heavy schedule.  It often takes at least three days to accomplish the desired change, during which time, you might not get the sleep you deserve.  Try a 3-day holiday weekend for example.  Also don't try to change the behavior during a time when your child is acutely ill.
• 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 awakens.
• Eliminate long daytime naps. If your baby has napped for more than 2 hours, awaken her. If she is in the habit of taking three naps during the day, try to change her habit to two naps each day by delaying the first nap.
• Don't change wet diapers during the night. Change the diaper if it is soiled or if you are treating a bad diaper rash. If you must change your child, use as little light as possible (for example, a flashlight), do it quietly, and don't provide any entertainment.
• If he's standing up in the crib, leave him in that position. Don't try to get him to lie down every time you go in. He will just spring back up as you start toward the door. He can lie down without your help. Encouraging him to lie down soon becomes a game. GOOD LUCK!