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.
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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:
- Going in to the baby
- Picking her up, and
- 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.