Baby Won’t Sleep: Here’s Why

HELP! MY BABY WON’T SLEEP!!!

You’re not alone. I know someone else who said that a few years back… ME.

Our first little one arrived 2 weeks early. But he fed well. He gained terrific weight. He hit all his milestones. There’s just one thing he didn’t do. LO did. not. sleep.

We tried everything (or rather, we thought we tried everything!) We rocked him in our laps for what seemed like days at a time. We walked the floor with him at 2 AM night after night. We tried leaving him to cry (against all recommendations). We used pacifiers, white noise machines, bouncy seats and baby swings. Everything worked… for about 10 minutes.

We asked friends with babies for advice. We even borrowed a copy of Ferber (and read it!)

Reading Ferber for me was the proverbial light at the end of the tunnel. In this book I first encountered the concept of “sleep associations“. It was a kind of epiphany for me. And my journey began. I started reading more about sleep and infant development. Then it all fell into place. I had planted the germ of and idea that was to evolve into my sleep coaching business.

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Don’t wanna sleep right now

I discovered that a powerful potential for normal sleep resides in every human being. The trick is to unlock it. There are no ‘sleep problems’ per se. There are only barriers that stand in the way of a baby or child and a restful night’s sleep!

Over the years, I’ve heard the cries of “Help! My baby won’t sleep!” hundreds, maybe thousands of times. Each story is unique. Each child and family has their own set of issues that contributes to a sleep problem.

But very often, each of these unique cases can be classified in its own group. I’ve made a catalog to share with you here. I’ll explain the broad sleep issue, then explain the elements of the fix. The key thing to remember is that each child is unique, so your story may be different, as will the remedy. The underlying elements, however, are the same.

Why Your Baby Won’t Sleep

1. She’s Not Tired

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I will sleep later

It’s 9:00 PM. You’ve been up since 4 AM with your 2-month old. You’ve fed and changed her what feels like a dozen times. You’ve gone shopping. You’ve done four loads of laundry. Oh yeah, and you cooked dinner for your husband, who strolls in at 6 PM looking fresh as a daisy. You look like you’ve been in a fight gone bad. You can barely keep your eyes open. So why is it the baby won’t sleep?

It could be that she’s already slept 16 hours in the last 24, and she just got up from a 3 hour nap at 7:00 PM! She’s just not tired enough to go to sleep yet!

Babies develop sleep-wake cycles just like we do. When they are very young, their stomachs usually set the clock. After a few weeks, they begin to respond to the structure imposed by the sun. That is, they learn that day is light and night is dark! They also respond to the structure imposed on the day by their parents: the day tends to start at the same time. She eats at the same time. She plays at the same time. And she naps at the same time.

The Fix

For a baby like this, I first make sure she’s healthy and getting enough to eat. Then we talk about her sleep patterns. We talk about a typical day for her. In this case, when she’s just had a huge nap in the afternoon, I recommend some tinkering with the nap schedule. It may involve moving the afternoon nap earlier in small steps, say 15 minutes at a time. Again, the fix when the baby won’t sleep because of the recent long nap is only an example. There are always little tweaks that I recommend for families.

2. She’s Overstimulated

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But I kinda LIKE stimulation!

Overstimulation is a real thing. It really can rev a baby’s motor so high that she cannot calm down enough to go to sleep. Maybe there’s been too much activity. There was a party in the morning. You listened to a rock station on the radio on the way home. You played all afternoon when she wasn’t napping. By the end of the day the poor baby is wired up!

Newborns and some young babies are able to protect themselves from overstimulation. They do this by ‘shutting it down’, and going to sleep. I call this “The Tilt Function“. As they develop, babies lose the Tilt Function and expose themselves to the risk of overstimulation on those really busy days. Some babies can handle a lot of stimulation, but some cannot!

Sometimes the baby becomes overstimulated because she has lost one of her naps that she really needs. Sometimes this happens ‘accidentally’ and sometimes it happens by design – at day care.

The Fix

The best way to fix overstimulation is to avoid it to begin with! If the baby’s day is too much for her senses, try cutting back on activities. If she needs that third nap and isn’t taking it, I can teach you some tricks to get that nap back!

On the day that the baby won’t sleep because she really is overstimulated, you may need to bend a few rules. That means, you may need to sit or rock with her for a while. Do this in a dark, calm place. You can run a white noise machine or hum quietly to her. It may be a bad night. But you’ll know how to avoid such nights in the future!

3. She’s Hungry

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I’m a kitten. I’m always hungry

This one is more common than I thought it would be. Babies are growing faster in their first year of life than they will ever grow later. They need a lot of calories. Some exclusively breastfeeding moms worry that their babies aren’t eating enough. This is natural because it’s hard to know how much the baby is eating if you can’t measure it! But sometimes a baby won’t sleep who is exclusively bottle fed! Rarely, a baby who has started taking solids is still not getting enough calories during the day.

In all these cases, the baby won’t sleep because her stomach keeps her awake. It’s a good thing, in a way. A baby needs to grow!

The Fix

The first step is to consult the pediatrician. You want to know if they baby is getting enough calories for her weight during the day. You want to know if she is gaining weight along her growth curve appropriately. If she is not getting enough calories, work with your pediatrician, or perhaps a nutritionist, to figure out ways to feed her up. A baby who eats well, sleeps well (and vice versa!)

4. She’s Over-Fed

This is the opposite of #3. Sometimes a baby won’t sleep at night because she’s eaten too much, not too little. Their stomachs are working double time to try and digest all the formula (and solids?). These babies are gassy and colicky. Often they are constipated. In that case, the baby won’t sleep because she needs to poop and cannot. Or sometimes she poops to much, and her full diaper won’t let her rest.

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Too much?

I see this a lot in babies who drink “spiked bottles”. These are bottles of formula or pumped breast milk that you’ve added cereal to. There is no reason to spike bottles, people (see below).

The Fix

Just as in #3, the first step is to consult the pediatrician. You want to know if the baby has a good weight for her age. You want to count up the calories she’s eating per 24 hours. This number varies, but she should get around 50 calories per pound of body weight per day. If she’s eating substantially more than this, this could be the reason baby won’t sleep. You should discuss it with your pediatrician. He/She will probably recommend that you cut back on calories. One thing is pretty certain, however. The pediatrician will recommend you stop spiking the bottle if that is what you are doing! Formula or breast milk are perfect by themselves!

5. She’s Got Bad Sleep Associations

This is a major cause of “baby won’t sleep”. It may be the major reason. Sleep associations are, very simply, those things that your baby associates with going to sleep. Some typical ones are darkness, swaddling, sucking on a pacifier, being rocked.

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But she won’t sleep without her binky!

What’s the difference between a “good” sleep association and a “bad” one? A good sleep association is something that will stay with the baby all night. Baby sleep cycles from shallow to deep, just like ours does. A bad sleep association is something that disappears, or is taken away, after we fall asleep. When we get to shallow sleep, we ‘take an inventory’ of all the things around us (our sleep associations), make sure they are all there, then we roll over and fall back asleep. We don’t even remember these partial awakenings.

A baby does this too. What if one of her sleep associations is being held by you? Unless you plan to hold her all night, she’s going to awaken partially at midnight and wonder where you went! That’s why being held is a bad sleep association.

Very often, the baby won’t sleep because the binky (pacifier) has become a bad sleep association for her. When the binky falls out of her mouth, as it surely will, she’ll ‘look around’ for it in the dark. Then she’ll get ticked off and become fully-awake. Then you have a crying baby!

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The Fix

Pay close attention to the events that surround the moment of sleep. Is she surrounded by all the things that will be there in 90-120 minutes when she partially wakes up? Do you hold her or rock her until she falls asleep? If so, she may associate holding and rocking with being asleep. No holding? No rocking? Baby won’t sleep!

Each case is different, but in general parents and I work on ways to put some time between the bad sleep association and the moment of sleep. First a few minutes, then more minutes. It’s essential to dis-associate these things in order to allow the baby to master her natural self-soothing technique.

6. She’s Got Colic

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No. That’s “cow lick”

I call this the “C” word. I hate colic. Everybody hates colic. By definition, no one knows what colic really is. The incessant crying for hours at a time, every night, at the same time, is enough to drive any parent nuts! I’m talking about babies who eat well and nap perfectly throughout the day. Then they turn into little devil-babies at night. It begins at 3 weeks of age and continues until 12 weeks.

Colic is a “diagnosis of exclusion”. That means, once you exclude all the other reasons why baby won’t sleep, you can call it colic. Some of these reasons are reflux (see below), over-feeding (see above), or under-feeding (also above).

The Fix

Parents hate this answer. You have to wait it out. If you and your pediatrician figure out that there’s no other reason why baby won’t sleep, then you have to wait. At 12 weeks of age, it will stop. These may be the longest 8 weeks of your life. But you will survive it. We all did.

7. She’s Got an Inconsistent Schedule

Again, this reason why baby won’t sleep turns out to be a lot more common than I imagined. It turns out that some (many?) babies are creatures of habit. They like having a regular day. They like things predictable. They don’t like change. They don’t like inconsistency. Having said all that, there are many babies who don’t mind chaos at all! But if the baby won’t sleep because she needs consistency and her day is chaos, you may have a difficult problem on your hands!baby won't sleep 9

Sometimes the schedule is fairly consistent except for one part of the day. I’ve had many clients who believe the baby won’t sleep because Dad comes home late and the baby wants to play with him! They’re right! She probably does want to play with him. The problem is her regular sleep-wake cycle wants her to be going to sleep at 9 PM, not to be playing with Dad.

The Fix

Easier said than done. For many families, chaos is more or less a way of life.  It would be great if every day were more or less the same, but the reality is that this just doesn’t happen for some families. But in every family, there are some ways that the day can be made as regular and as predictable as possible. For example, there may be a four-hour stretch at the beginning of the day when mom and baby are alone together. This is a good time to try and establish a routine of eating, playing, and sleeping. If you can succeed in introducing order in one part of the day, then you can work on other parts of the day as well.

8. She’s Got Reflux

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Wrong way. Should be down

Sometimes the baby won’t sleep because food comes up instead of going down. That’s reflux in a nutshell. Milk or food that is supposed to pass into the baby’s intestines comes back up toward her mouth instead. Sometimes acid from the stomach irritates the baby’s esophagus. These babies seem to be in pain. They make funny faces. Many, but not all, of these babies also spit up. Not every baby who spits up has the painful symptoms of reflux.

Some parents tell me that the baby won’t sleep unless she’s being held upright. Or she won’t sleep unless she’s in the bouncy chair. This is a clue. Other parents tell me that the baby always seems fussiest right after eating, especially if they put her down right away.

The Fix

The first step, once again, is to discuss the possibility of reflux with your baby’s doctor. While you are doing this, there are some things you can try. I call these “anti-gravity methods”. The point here is to let gravity be the baby’s friend, not her enemy. If food is supposed to travel down, let gravity help it go down. I recommend keeping these babies up on an angle virtually all the time, except when changing their diapers. An angle of 30 degrees is possible, but you may have to buy more than one wedge at the baby store. When I say “angle” I mean the entire body, not just one part of it. You don’t want the baby to do an “abdominal crunch’; this might only make the reflux worse. You wan’t her entire body ‘planked’ up at an angle of 30 degrees.

Sometimes doing smaller feeds more frequently can cut down on reflux. If anti-gravity alone doesn’t work, I sometimes recommend adding this technique.

If neither trick works, your pediatrician and you can try some other methods. There may be dietary changes she can make. Sometimes medications can help. The good news is that practically every baby with symptomatic reflux gets better by her first birthday.

9. She’s Sick

Sometimes the baby won’t sleep because there’s something wrong. She’s coming down with something. Or she’s already caught something. Usually you can tell this reason from the other reasons because the baby won’t be right throughout the day, not only at sleep times. She may or may not have a fever. Sometimes, the best way to tell if a baby is sick or not is to ask how well she is feeding. A baby who is feeding well may be sick, but she’s not SICK, if you know what I mean. I worry a whole lot less about about when a baby won’t sleep but continues to eat well, than I do about a baby who won’t sleep and won’t eat!

The Fix

If you have any concerns or question at all that the baby may have an illness, consult your pediatrician. The overwhelming majority of the time, when the medical problem is fixed, the baby will go back to sleeping well again!

10. She is Hypersensitive

Finally, the baby might be more sensitive to the sensations of her world than other babies. For example, the baby won’t sleep because she hears every toilet flush in the house and it wakes her up. Or if you go in her room to check on her and you ever-so-slightly jostle the crib and it wakes her up! Or the baby won’t sleep if there is too much light in the room.

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So I’m sensitive, so what? I’m also cute!

These are real example from families I’ve helped. On further questioning, I often learn that one or both the parents were “just like this” when they were babies. Grandparents can be a helpful resource when trying to figure out why the baby won’t sleep.

The Fix

Create a “sensory deprivation space” in the baby’s room. Install black-out shades and carpeting to muffle footsteps. The exception may be a white noise machine. Sometimes, but not always, these devices can help filter out noises from around the house that might wake the baby. It sounds gross, but sometimes I recommend that the parents wait until the baby is awake to flush the toilets. I’ve actually seen this work at least once.

Sleep, Baby! is Here for You

If these ideas don’t work for you, or if the reason your baby won’t sleep doesn’t appear on the list, contact me. I can help!

 

 

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?

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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:

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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!

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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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Why Your Toddler Won’t Nap… And How to Fix It

Q: My toddler won’t nap! What can I do?

She is 2 years and four months old. Until about two weeks ago she took a nap every afternoon after lunch for two hours. Now at nap time she complains that she wants to do something else. Anything else but nap. By 6 o’clock she’s so cranky that she throws tantrums and she never throws tantrums! Help!

True story… This is a very common situation. I get a lot of questions like this. In order to answer them, I need a lot more information!

A: So, your toddler won’t nap!

First, I need a lot of background. I ask about the child’s sleep history and her developmental history. Was she full-term or premature? Did she feed and grow normally during the first two years (I ask specific questions about milestones). Then I ask a sleep history. What is her current daily routine like? I’m particularly interested in nighttime sleep: how many hours does she get? Does she sleep continuously or does she wake up? If so, how many times? I also ask about diet and exercise (Really! These things matter!)

With this toddler, it turns out she was getting enough sleep – but the way her sleep was distributed was a little screwy.

Her parents had a terrific bedtime routine: everything from dinner time to bedtime was completely regular and predictable. The girl went down without a fuss at 7PM sharp (in her toddler bed!). She would wake up at 7AM, have a bottle in her bed, and a short time later would fall asleep again until 9AM, when she’d be up for the day. For several months, she’d take a brief nap in the afternoon. Now she wasn’t napping at all, and the tantrums were beginning.

The Routine

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I’M NOT CRANKY!!!

Her parents didn’t count the 7 AM bottle as an awakening and a nap, they counted it as part of her nighttime sleep. This little girl was getting 14 hours of sleep per day, which is on the high end for a toddler of her age. But she was getting all this sleep basically in one shot.

When most children drop down from two naps to one, it’s the morning nap that goes. They tend to keep the afternoon nap. This child kept her morning nap but lost the afternoon nap. As a result, by bedtime she would have stayed up 9 straight hours, which was a lot for her. She would become overstimulated and cranky. This actually made it more difficult for her to go to sleep at night!

Her fix

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I LOVE daycare!

I explained to these parents that their daughter was getting great sleep at night: 12 hours! By the afternoon, she was not getting sleepy, because she had already taken a two-hour nap in the morning!  I thought that when she woke up in the morning, she should be up! But instead, she was conditioned to have her bottle and fall back to sleep. I pointed out that what she was doing was holding on to her morning nap beyond the point where she really needed it. She probably still needed the nap, only later in the day.

The fix was remarkably simple. Frankly, I was surprised how easy it was. I recommended that at 7AM, mom should start a new morning routine. She’d invite the girl to get up, have her bottle in the kitchen, eat a healthy breakfast and start her day. This activity alone was enough to stimulate the girl enough to convince herself she was awake and ready to play. By 1 o’clock in the afternoon, she began to get sleepy and went down for a nap. She’d get up at 3, and then would go down for the night at 7PM.  No crankiness, no tantrums.

Need a SLEEP COACH?

Overstimulation

There are many other reasons why a toddler’s nap schedule can get screwed up. Some toddlers have the kind of temperament that makes them sensitive to stimulation. In order to nap, they need low light and quiet. If there is too much sound, light, or activity, they will want to pay attention and stay awake.

Many toddlers nap badly at daycare. Even though most daycares do a terrific job of lowering the lights, playing soft music, and limiting noise and activity, sometimes it doesn’t work. The sensitive toddler won’t nap because she’ll be stimulated by whatever sound and activity is going on at nap time.

On the other hand, some parents tell me that daycare sleep is great but the toddler won’t nap at home! With further questioning, I usually find that the toddler is being overstimulated at home more so than at daycare!

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Yeah.. no

In both these situations, if your toddler won’t nap and the reason is overstimulation, the fix is to try to reduce the amount of activity, sound, and light as much as humanly possible.

The Cheetos Sweetos Nap

Diet matters. Sorry, folks, it just does.

Here’s another true story: I did a consult for a family that had three children. One in first grade, a pre-schooler (age 3), and a baby just turned one. The reason for the consult was that the 3-year old wasn’t napping.

The mom had all three children with her when we sat down to talk. I spotted the sleep problem immediately before we even started getting to know one another. There was an open bag of Cheetos Sweetos being passed around and all of them were eating them… even the baby! Everyone had a sippy cup of juice.

Sure, they’re tasty. But Cheetos Sweetos is not food. It is the enemy of sleep. These poor kids were so amped up on sugar that it’s a wonder any of them slept at all. They got plenty of activity – this was obvious from watching them, but their diet was awful.

The Three Legs

I never get tired of reminding people that all of health and wellness stands on three legs: diet, exercise and sleep. All three of these are closely related to one another. Good habits in one domain reinforce the other domains. For example, kids who eat well tend to get better exercise, and they sleep better. Kids who sleep well tend to have more energy for exercise… and so on.

But you can also see how poor habits in any one domain can throw off the others. In the case of the Cheetos Sweetos family, poor diet was probably the most important key to understanding why the toddler won’t nap. So the take home messages are identical to the three legs of health:

  • Eat Real Food: If it doesn’t look like it did when it came out of the ground or from the animal, it’s not real.
  • Get Plenty of Vigorous Exercise: Humans are meant to move. Make sure the kids get at least an hour of real physical activity every day.
  • Get Plenty of Sleep: Keep consistent, predictable schedules, as much as possible. Avoid overstimulation. Listen to sleep cues, but provide structure!