Bottle or Binky in Bed: Bad Idea!

Have you done this? This is for you parents who said they’d never do it. Your toddler sleeps with a bottle or binky in her mouth. You said you’d never do it, but there it is! How did it happen?

The Slippery Slope

It’s a real thing, folks. When you step out on to the edge of the slippery slope you end up at the bottom before you know what happened. bottle or binky 2

I’ve been there. Trust me, I know what it’s like to suffer from toddler-induced sleep deprivation. You will do anything (within reason) to get the little one to settle.

Perhaps you’ve even said this to yourself: “I’ll give her the bottle or binky just this once. I don’t want it to become a habit. I just need to get to sleep!”

A week, maybe a month later, you remember what you said to yourself and the feeling of guilt creeps in. Because the binky is still in the toddler’s mouth, or the bottle is still in the crib. I’ve been there as well.

The Problems Bottle or Binky Cause

Things seem ok for now. She’s sleeping after all, isn’t she?

bottle or binky1
Is that juice in that bottle?

Yes. For now she is. But what if the binky falls out and she goes looking for it? If she doesn’t find it and wakes up fully, she’ll be pissed! This is because the object in her mouth has become a sleep association. That is to say, something that she associates with going to sleep. If that thing is no longer present when she arrives at a shallow sleep phase in a couple hours, she may go looking for it and fully rouse herself.

What about her new teeth? Could they grow in crookedly because of the rubber object in her mouth 8 hours straight? Yes, it could happen. She might also increase her risk for ear infections.

Then there’s the speech thing.

Don’t Talk With Your Mouth Full!

I have met dozens of mothers who worry that their toddlers aren’t speaking when they should. One look at the toddler can tell the story. If her mouth is full of binky, or if she has a bottle hanging from her lips at all times, she probably is going to have a tough time speaking! I’ve consulted on toddlers who do manage to learn to speak around their binkies, but I must say this is rare. Suffice to say these kids aren’t easy to understand. A friend who is a speech pathologist has managed more than one case by simply popping the binky out of her patient’s mouth!

More Teeth Problems

Another typical “slippery slope” story is the problem of “milk bottle cavities“. I’ve seen my fair share of kids who’s mouths look like this:

bottle or binky
Sorry for the disturbing photo, folks

It turns out that bacteria love sugar. When you bathe baby teeth in sugar for several hours at a time, bacteria that cause cavities have a feast! I know that these parents never wanted their toddler’s two top teeth to rot! I know they only wanted the little one to get to sleep and this was the “only way” to get it done. Well, of course it wasn’t the only way, but once you step out onto that slippery slope, you end up at the bottom before you know what hit you.

The sugar in breast milk or formula is fine for your baby; you’d have to admit it’s good for her! But it is meant to be sucked down and swallowed. Milk was never meant to pool in a human’s mouth for any length of time. The effect on teeth tells the story.

Need a SLEEP COACH?

What goes for milk goes triple for juice. Juice is not fruit. Juice is flavored sugar dissolved in water. There is no good dietary reasons for your baby to consume sugar. How much more so is there no reason for sugar-water to swirl around in her mouth. It does nothing but provide a tasty meal for those bacteria!

Bottle or Binky Before Bed?

As I’ve said before, I’m a big fan of the binky. It can be the breastfeeding mom’s best friend for the first six months of the baby’s life. Prior to 4-6 months, your baby needs some external source of soothing. Beyond this point, the baby is able to do it herself, so she doesn’t need soothing aids. This is when the binky becomes something much less than a friend. It becomes a habit that you desperately wish you had broken earlier. The longer you wait, the tougher it gets. A “window of opportunity” begins to close at around 9 months. By one year of life it takes a strong parent indeed to pry the window open again!

bottle or binky 4
Now see? She’s addicted to it!

As for the bottle, it has no place in the crib, ever.

If you absolutely must give a bottle to a toddler in a crib, it should be a bottle of water (sugar-free) and you should do this only on one particular situation (discussed in “The Three Temptations“). After the child has had her sip, she doesn’t need it any more and you can take it away.

Spiked Shoes

I once heard an ethicist say he wished he could climb down the slippery slope with spiked shoes. Sorry. You can’t do that. No one can. The best way to fix the problem of a toddler who won’t sleep without a bottle or binky is never to give either in order to make them sleep. For a binky, you have some leeway until 6 months. With the bottle, it should be easier:

Just. Say. No.

Climbing Back Up the Slope

But if you do find yourself at the bottom of that slippery slope, not all hope is lost. If your toddler really needs something with her in bed, you can replace the bottle or binky with another transitional (or comfort) object. Whatever it is, it should be something she can put in her mouth that will be safe for her. A blanket or stuffed animal can be a good substitute.

Another trick that works well for some parents is a “goodbye” ritual, timed to coincide with a big event like a birthday. My sister prepared a goodbye ceremony for her daughter’s binky when the girl turned 3. They went and threw away all the binkies in the dumpster, and then and bought a nice present for the little girl. My niece was very enthusiastic about the entire thing.

Of course, it’s ideal to be able to avoid transitional objects and goodbye rituals in the first place!

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Melanie and Jim: A Case Study

The story Melanie and Jim is just one of many stories of couples that sought my advice (or bought my book!) for a sleep problem they were having with their baby. I’ve changed all information that might identify them in order to preserve their privacy.

Baby Name: Darcy, age 4 months, is the healthy baby girl, product of an uncomplicated pregnancy, labor, and delivery. Darcy has been exclusively breast fed since birth

Mother: Melanie, 26 years old married, first child, living in Framingham MA.  Married three years to Jim.

About Melanie and Jim

Melanie is a graphic designer who runs her own business.  Jim is an attorney at his first job post-law school. Melanie would like to return to working but is not taking new clients until Darcy will be at least a year old. Then her mother (Darcy’s grandmother) will assist with child care during the day.

The problem:   Melanie and Jim cannot sleep.  The sleep deprivation is creating an enormous amount of stress for Melanie, for Jim and for their marriage. They fear it’s negatively affecting their daughter and her relationship with them. They are worrying now that they are not enjoying parenthood as much as they were. Melanie describes feeling “like she’s at the end of her rope”.

They are begging for some help getting Darcy to sleep long enough for the parents to get some sleep themselves and regain their sanity.

Melanie and Jim filled out an Intake Form and made some guesses as to what they chose as their SMART goals. They scheduled a consult with me. I spoke with both parents together.

After explaining again the stresses, physical, emotional that they were feeling, I asked Melanie to walk me through a typical day for Darcy.

Melanie and Jim
Picture day!

We talked about her feeding schedule, how often and for how long. The baby had just been to the pediatrician to be weighed, so we knew that Melanie’s milk supply was adequate. The baby was peeing and pooping normally.

She was feeding on demand, but Darcy “fed like clockwork” every two hours, including at night. Lately she’d been waking up every 90 minutes at night, adding further stress.

I asked Melanie specific questions about how she fed Darcy before bed and naps. Melanie told me that Darcy would fall asleep at the breast. Always. Melanie would then put Darcy’s pacifier in her mouth, swaddle her, and put her down in her crib.

Darcy would sleep well as long as she had the pacifier in her mouth. Sometimes it would fall out and she would stay asleep. But lately she would root and “look” for her pacifier, rouse herself and cry, about 90 minutes after falling asleep.

Could it be Sleep Associations?

I wondered aloud if part of the problem might be that Darcy’s falling asleep at the breast was causing her to associate sleep with breastfeeding. In other words, maybe nursing was becoming a sleep association.

Melanie and Jim
Surprise?

Darcy was four months old now, and she was a normal thriving full-term baby, so I felt it was possible that she was now able to develop her own internal self-soothing mechanisms. I speculated that Darcy might be developing a more mature sleep-wake cycle. I explained that this would mean that Darcy was now cycling between deep and shallow sleep. When she would arrive at the shallow stage, she would arouse briefly, look around for the breast or the pacifier, not find it, and become distressed and cry. It could be the case, I explained, that if Melanie and Darcy could make some space between breastfeeding and falling asleep, that the baby could develop her abilities to fall asleep on her own.

Melanie, Jim, and I began to develop a sleep plan. They both felt that if bad sleep associations were interfering with Darcy’s ability to stay asleep, then they would be willing to tolerate a bit of crying on Darcy’s part if it meant she’d be able to fall asleep on her own.

We developed a schedule based on the schedule Melanie was already following. The only difference was that Melanie would try to keep Darcy awake through the end of the feed, first for a minute, then gradually up to ten minutes before putting her down. We would do this over 5 days.

We discussed ways to keep Darcy more stimulated so that she wouldn’t sleep while feeding. We talked about keeping her baby clothes open so that the baby could feel some cooler air on her skin. Or Melanie could play with Darcy’s feet or blow gently on her face.

Then Melanie would swaddle Darcy and place her, awake, in her crib, stroke her a few times, and leave the room.

Melanie and Jim make SMART Goals

Based on this plan, Melanie and Jim wrote up a SMART goal for Darcy. She would sleep four hours straight at night, and she would accomplish this goal in seven days.Melanie and Jim

We also decided that we would try to go without the pacifier, as this might also become a sleep association for Darcy.

We followed up by email and phone several time over the next few days. The first two days were rough, according to Melanie.  Darcy would cry and fight her way out of the swaddling blanket. Melanie confessed she’d put the pacifier in and Darcy would fall back asleep.

The good news was that Darcy was indeed settling herself to sleep.  It turned out that she would cry for about 3-4 minutes after being put down, but she’d fall asleep.

Then at day four the magic happened

At 7 PM Melanie nursed Darcy, put her down in the crib awake, and left the room.  Darcy fussed for a few minutes and settled.  On the baby monitor, Melanie could see Darcy sleeping quietly.

And she stayed asleep until 11 PM.

She started to stir. Melanie took her out, changed her and breast fed her again for 10 minutes.  She struggled to keep Darcy awake because the baby was so sleepy. She isn’t sure Darcy was awake when she put her down. But the baby slept again until 3 AM.

Melanie and Jim
Is there such a thing as a 20-hour stretch of sleep?

Two four-hour stretches in one night!

Over the next few weeks, Melanie worked on making sure that she put Darcy down surrounded by all the things that would be there when she had her periodic brief awakenings every 1 ½ – 2 hours. Darcy was developing good sleep associations.

By five months she was sleeping from 11 PM to 5 AM, a six-hour stretch.  Se was feeding more often during the day to compensate, but Melanie did not care: she was ecstatic because everybody, baby and parents, were sleeping better at night. Melanie said she was starting to feel “almost normal again”.

Now that they were both better rested, Melanie and Jim told me that they really felt good again about being parents. The admitted that they had feared they’d turn out to be terrible parents and they’d hate the whole experience. Now they were both feeling confident and competent to handle anything that parenthood might throw their way.

Melanie and Jim were able to restore their sanity and begin to enjoy being parents because I helped them drill down into what Darcy’s real sleep problem was: she had begun to associate being at the breast with falling asleep. Together we worked out a plan to dis-associate nursing and sleeping, and it worked!

This all occurred a few years ago. Melanie and Jim had a second baby, another girl. This second baby had no sleep problems at all. Melanie stayed wary of negative sleep associations and made sure #2 daughter didn’t develop any.

Click here to learn out YOU can get your baby to sleep!

Getting Baby to Sleep: A Case Study

The following is the story of a couple that sought my advice to help get their baby to sleep. I’ve changed all information that might identify them in order to preserve their privacy.

Baby Name: Darcy, age 4 months, is the healthy baby girl, product of an uncomplicated pregnancy, labor, and delivery. Darcy has been exclusively breast fed since birth

Mother: Melanie, 26 years old married, first child, living in Framingham MA.  Married three years to Jim.

Melanie is a graphic designer who runs her own business.  Jim is an attorney at his first job post-law school. Melanie would like to return to working but is not taking new clients until Darcy will be at least a year old. Then her mother (Darcy’s grandmother) will assist with child care during the day.

The problem

Melanie and Jim cannot sleep.  The sleep deprivation is creating an enormous amount of stress for Melanie, for Jim and for their marriage. They fear it’s negatively affecting their daughter and her relationship with them. They are worrying now that they are not enjoying parenthood as much as they were. Melanie describes feeling “like she’s at the end of her rope”.

Need a SLEEP COACH?

They are begging for some help getting the baby to sleep long enough for the parents to get some sleep themselves and regain their sanity.

Melanie and Jim filled out an Intake Form and made some guesses as to what they chose as their SMART goals. They scheduled a consult with me. I spoke with

baby to sleep
Sleep. Something Melanie and Jim were not getting

both parents together.

After explaining again the stresses, physical, emotional that they were feeling, I asked Melanie to walk me through a typical day for Darcy.

We talked about her feeding schedule, how often and for how long. The baby had just been to the pediatrician to be weighed, so we knew that Melanie’s milk supply was adequate. The baby was peeing and pooping normally.

baby to sleep
Darcy nursed a LOT

She was feeding on demand, but Darcy “fed like clockwork” every two hours, including at night. Lately she’d been waking up every 90 minutes at night, adding further stress.

I asked Melanie specific questions about how she fed Darcy before bed and naps. Melanie told me that Darcy would fall asleep at the breast. Always. Melanie would then put Darcy’s pacifier in her mouth, swaddle her, and put her down in her crib.

Darcy would sleep well as long as she had the pacifier in her mouth. Sometimes it would fall out and she would stay asleep. But lately she would root and “look” for her pacifier, rouse herself and cry, about 90 minutes after falling asleep.

I wondered aloud if part of the problem might be that Darcy’s falling asleep at the breast was causing her to associate sleep with breastfeeding. In other words, maybe nursing was becoming a sleep association.

baby to sleep
A cat nap before heading back inside

Getting Baby to Sleep

Darcy was four months old now, and she was a normal thriving full-term baby, so I felt it was possible that she was now able to develop her own internal self-soothing mechanisms. I speculated that Darcy might be developing a more mature sleep-wake cycle. I explained that this would mean that Darcy was now cycling between deep and shallow sleep. When she would arrive at the shallow stage, she would arouse briefly, look around for the breast or the pacifier, not find it, and become distressed and cry. It could be the case, I explained, that if Melanie and Darcy could make some space between breastfeeding and falling asleep. For the baby to sleep, she would have to develop her own abilities to self-settle.

Melanie, Jim, and I began to develop a sleep plan. They both felt that if bad sleep associations were interfering with Darcy’s ability to stay asleep, then they would be willing to tolerate a bit of crying on Darcy’s part if it meant she’d be able to fall asleep on her own.

We developed a schedule based on the schedule Melanie was already following. The only difference was that Melanie would try to keep Darcy awake through the end of the feed, first for a minute, then gradually up to ten minutes before putting her down. We would do this over 5 days.

We discussed ways to keep Darcy more stimulated so that she wouldn’t sleep while feeding. We talked about keeping her baby clothes open so that the baby could feel some cooler air on her skin. Or Melanie could play with Darcy’s feet or blow gently on her face.

Then Melanie would swaddle Darcy and place her, awake, in her crib, stroke her a few times, and leave the room.

Based on this plan, Melanie and Jim wrote up a SMART goal for Darcy. She would sleep four hours straight at night, and she would accomplish this goal in seven days.baby to sleep

We also decided that we would try to go without the pacifier, as this might also become a sleep association for Darcy.

We followed up by email and phone several time over the next few days. The first two days were rough, according to Melanie.  Darcy would cry and fight her way out of the swaddling blanket. Melanie confessed she’d put the pacifier in and Darcy would fall back asleep.

The good news was that Darcy was indeed settling herself to sleep.  It turned out that she would cry for about 3-4 minutes after being put down, but she’d fall asleep.

baby to sleep
Blessed relief

Then at day four the magic happened.

At 7 PM Melanie nursed Darcy, put her down in the crib awake, and left the room.  Darcy fussed for a few minutes and settled.  On the baby monitor, Melanie could see Darcy sleeping quietly.

And she stayed asleep until 11 PM.

She started to stir. Melanie took her out, changed her and breast fed her again for 10 minutes.  She struggled to keep Darcy awake because the baby was so sleepy. She isn’t sure Darcy was awake when she put her down. But the baby slept again until 3 AM.

Two four-hour stretches in one night!

Over the next few weeks, Melanie worked on making sure that she put the baby to sleep surrounded by all the things that would be there when she had her periodic brief awakenings every 1 ½ – 2 hours. Darcy was developing good sleep associations.

baby to sleep
Almost normal

By five months she was sleeping from 11 PM to 5 AM, a six-hour stretch.  Se was feeding more often during the day to compensate, but Melanie did not care: she was ecstatic because everybody, baby and parents, were sleeping better at night. Melanie said she was starting to feel “almost normal again”.

Now that they were both better rested, Melanie and Jim told me that they really felt good again about being parents. The admitted that they had feared they’d turn out to be terrible parents and they’d hate the whole experience. Now they were both feeling confident and competent to handle anything that parenthood might throw their way.

Melanie and Jim were able to restore their sanity and begin to enjoy being parents because I helped them drill down into what Darcy’s real sleep problem was: she had begun to associate being at the breast with falling asleep. Together we worked out a plan to dis-associate nursing and sleeping, and it worked!

This all occurred a few years ago. Melanie and Jim had a second baby, another girl. This second baby had no sleep problems at all. Melanie stayed wary of negative sleep associations and made sure #2 daughter didn’t develop any.

baby to sleep
Happy ending

They referred Melanie’s sister to me when Darcy’s aunt was having trouble getting her baby to sleep. And Jim told a few associates at his firm about me and I ended up being the unofficial “sleep consultant to [Jim’s Firm]”

 

 

 

The Three Temptations

This is a story about The Three Temptations.  And it’s a true story: one hundreds of parents have told me.
Mom and Dad will buy a phone consult about their nine-month old daughter.  It turns out that nobody in the house has had a good night’s sleep since baby was born. They are physically and emotionally exhausted – you can hear it in their voices. They are fairly begging for relief. All they want is a few hours in a row of sleep!

I listen to the story and remember my own sleep deprivation when our boys were this age. I remember how that physical and emotional exhaustion can take a toll on relationships.

At one point in the story, the parents tell me a key piece of information: Baby girl falls asleep at the breast.  Boom.  I believe we’ve found our answer. It all has to do with a temptation that can be irresistible in the middle of the night when mom and dad are exhausted, but it’s critical to solving baby’s sleep problem.

When parents tell me that their baby (four months or older) wakes up every two hours during the night, one of the first things I ask about are sleep associations. I want to know what surrounds the baby at the moment of sleep, since these are the things we want surrounding the baby when she moves into shallow sleep every two to three hours.

  • Is the baby in the place where you plan to have her sleep throughout the night (hopefully!)?
  • Is she nursing or taking a bottle while she falls asleep?
  • Does she have a binky (pacifier) in her mouth?
  • Is she making contact with mom’s or dad’s body while she falls asleep?
  • Was some kind of moving mobile or sleep-toy on that turns itself off?

If the answer to any of these question is yes, we probably have found why the child wakes so frequently at night. The solution is to remove the bad association sooner rather than later. In my experience, cold-turkey is the only effective approach. Weaning a baby away from most bad sleep associations turns out to be more difficult than it sounds.

Need a SLEEP COACH?

For example, it’s notoriously difficult to wean a baby off a pacifier. As long as the binky remains in the house, the temptation to give it back to the baby for any reason is simply too strong.

Think about this: is there any way to wean a baby off of becoming used to falling asleep in your bed, when you want her to spend the night in her crib?

Nursing to sleep, on the other hand, lends itself much better to weaning because the object of the exercise is to increase the amount of time between the last feeding and the moment the child falls asleep. In practice, however, the toughest and most important step is the first one: taking the baby off the breast or the bottle before she is asleep!

To troubleshoot sleep associations, take inventory.

See what things she’s surrounded by at the moment of sleep and make sure those are the things that will be there in two to three hours. If any of those things are difficult or impossible to reproduce in two to three hours, it’s best to work at changing or removing them.

The Three Temptations, and How to Avoid Them

For a baby who has developed her own internal soothing mechanisms but who wakes in the middle of the night and demands attention, I recommend a strategy I call “Avoiding the Three Temptations.” The temptations are:

  1. Going in to the baby
  2. Picking her up, and
  3. Giving her something to eat.

I counsel parents that if they cannot resist the temptation to go in to see their fussy baby, they should resist the temptation to pick her up. Instead, I recommend stroking the baby’s back and talking to her calmly and reassuringly.

But if mom cannot resist the temptation to pick the baby up, she should resist the temptation to feed her. Instead, she should make calm sounds and gently rock the baby.

But if mom/dad cannot resist the temptation to give the baby something to eat, they should not breast-feed or formula-feed the baby!

Instead: give the baby a bottle of water. (Note: Never give pure water to a baby younger than four months of age; there’s a small but measurable risk that the baby’s blood may become diluted.) The baby does not want water. Since most babies are smart enough to reject less-than-enticing incentives for waking up, eventually, usually after a night or two, the baby realizes that waking up for water is not worth her while. Then the parents can work on resisting the first two temptations! The three temptations are too many.

 

Sleep Associations: What I Learned from “The Juggler”

The story I’m about to tell you, about The Juggler, is really a story about sleep associations:

 

The Problem

The Juggler was 2 years old when I met him. His mother called me for a consult because the boy just would not sleep through the night. Mom had been back to work for over a year, but the sleep deprivation she was suffering from was seriously affecting her productivity. She and her husband wanted to have another child, but they were so exhausted they didn’t have the strength or the will to “work at it.” And frankly, mom admitted to me, if number two was going to sleep as badly as number 1, they weren’t sure they’d survive a second child!

I went to meet this mom at a cafe. She brought the boy with her. What I saw simply astounded me: This boy had a binky (pacifier) in his mouth, and one in each hand.

Need a SLEEP COACH?

As his mother began to tell her story, out of the corner of my eye I caught a glimpse of the boy doing something I had never seen before: he would pop the binky in his mouth out into one hand and replace it with the binky in the other, then repeat the action with the other hand. He did this fast, like he was practiced at it.  And he was. It was impressive to watch, in an odd sort of way.

“Holy Moly, he’s juggling!” I had to interrupted the mom.

“Yup. He does that all day.”

“May I assume he sleeps with three binkies as well?” I asked mom.

“Well, he doesn’t sleep very long,” mom replied, “That’s why we’re here”

Then came the “ah-hah” moment.

The Solution: Sleep Associations

Mom told me that she thinks the boy wakes up at night when the binky would fall out of his mouth.  She would respond to his cries by dragging herself into his room, popping the binky back in his mouth, and dragging herself back to bed.

What this boy had done was develop a bad sleep association. His parents tolerated it because they had grown used to it for one thing, and for another they were kind of amused by the juggling act.

But the juggling act was a sign of the most common sleep problem I encounter in my practice. I’d say that > 90% of the consults I perform involve bad sleep associations and how to manage them.

In future posts, I’ll tell more stories about bad sleep associations and how I taught parents to get rid of them!

Troubleshooting Sleep Problems

If parents have followed my sleep method and it’s still not working, there are a number of ways of troubleshooting sleep problems that we pursue until we solve the problem.

Overstimulation

Troubleshooting 101:
I start by asking parents to describe their bedtime routine. I think of the bedtime routine as a series of highly predictable events that begins at your baby’s dinner time and ends when she falls asleep. The time frame we are talking about may be anywhere from 30 to 60 minutes in length. I listen particularly for indications that the baby may be overstimulated during this period. For example, is the lighting bright and harsh? Is the television on, even softly? Is there music playing? Are there a lot of people talking loudly? Is everybody passing the baby back and forth among themselves? If it turns out that there are too many stimuli, I discuss ways to reduce them, which sometimes is more easily said than done. In some homes there are simply too many people and too much surrounding chaos to reduce stimulation. Dr. Spock would argue that this is not necessarily a bad thing and that babies will get used to it, but Dr. Weissbluth and I would not agree with him. In general, less stimulation is better than more, and the empiric research seems to corroborate this. The trick is finding a way to reduce stimuli. The solution may be to find a quiet but well-ventilated corner of the house or apartment where light, sound, and tactile stimulation can be kept to a minimum.

Need a SLEEP COACH?

Teething

Teething pain often interrupts the process of getting a baby to learn to go to sleep. At around four months of age, give or take, a baby may start drooling much more than before and may start grinding her fist into her mouth. This is likely the start of the teething process, though actual teeth may not appear for eight months.

Colic

Colic almost always happens when babies and their parents want to be sleeping. Once all the other causes of crying have been ruled out (baby just ate so she can’t be hungry, diaper is clean, she’s not constipated, and so on), you might settle on colic as the cause. Troubleshooting colic is a subject unto itself, and beyond my scope in this post!

Constipation

This is actually a subcategory of colic. Many babies wake up crying because they have to poop and they can’t. There are many easy ways to help a baby through constipation problems. Your pediatrician can help you with these

Need for more calories?

Many of my mom-clients are so successful that their babies outgrow their supply! A healthy baby that is born to a healthy mother and grows as fast a human being can grow eventually reaches the point where 20-calorie-per-ounce breast milk or formula is no longer sufficient for her needs throughout the entire day. Sometimes the baby will signal this change by waking up in the night at times when she used to sleep. This phenomenon is real but is often short-lived because feeding is so often a self-regulated phenomenon. Breast-fed babies will stimulate their mothers to make more milk during the day, and formula-fed babies will drink larger or more frequent bottles. Sometimes it works, sometimes not.