Premature baby sleep training is a special kind of sleep training.
The basic principles of sleep training apply, with a twist. We have to pay attention to a couple key questions. “What is your baby’s corrected gestational age?” and “Does your baby have any special difficulties related to her prematurity?”
I will review some basics about preemies and sleep training. Then I’ll talk about which sleep training methods are best for premature babies and why.
Premature Baby Sleep Training
The most important thing to know about premature babies is the most obvious. They were born early! But it might be better to say that they were born before they were ready. Harvey Karp would argue that even full-term babies are born before they are ready to be here on earth, but that is another subject!
Sometimes a premature baby will be born before her lungs are ready to breathe air on earth. These babies obviously need to stay in the Neonatal ICU (NICU) until they can breathe on their own. Still other preemies are born before they are able to eat on their own. They too need to stay in at least a special care nursery until they can “remember to eat”.
But the most important difference for our purposes is premature baby sleep. Premature babies sleep differently from full-term babies because, just like their lungs and stomachs are immature, so are their brains.
Turn Down the Noise!
An important difference between us grown-ups and babies is that we have a filter. We can filter out sounds, feelings, smells, tastes, and sights that interfere with our ability to focus. Babies can’t do this. They have to pay attention to everything. And so it’s easier for babies to become overwhelmed by too much sensation. This is what we mean by “overstimulation”. When babies get overstimulated they get fussy, they cry more, they eat poorly, and they don’t sleep!
How ever you decide to sleep train your preemie, you have to keep this in mind, particularly if she is still younger than her due date. The risk of overstimulation can be too high with babies with a corrected gestational age less than 40 weeks. For these babies it may be best to put off sleep training.
So You Say You’re Ready for Premature Baby Sleep Training?
Maybe so, but is the baby ready? There are a couple of ways to tell. First, does the baby weigh around what a full-term baby weighs? If she weighs less than 5 lbs 8 oz, it may be difficult. She’ll need to do a lot a feeding for catch-up growth. I recommend discussing with the pediatrician if you want to start at a smaller weight.
Does the baby have any problems related to her prematurity? For example, many preemies have reflux. A premature baby with reflux may be fussy and have trouble settling. Other premature babies go home from the hospital needing oxygen. These are babies I might not recommend sleep training until they are breathing room air. Again, this is something to discuss with the pediatrician.
All the various sleep training methods fit into two broad groups: baby-led and parent-led. Briefly, baby-led methods lean heavily on paying attention to the premature baby sleep cues. These are eye-rubbing, yawning, and beginnings of fussiness. Parent-led methods lean heavily on providing structure for baby sleep. This includes starting meals at the same time every day, and encouraging naps at the same time every day.
The reality of premature baby sleep training is much simpler: it’s a combination of baby-led and parent-led methods. This is sometimes referred to as “combination” sleep training. That is to say that the most successful baby sleep training that I know of involves a combination of following baby’s cues and providing structure. This is the method I recommend in my practice.
I do make a slight exception for premature babies. Because feeding and growing is so important, I lean more toward following her feeding cues. Your pediatrician may have given you target for the number of calories she should have every day. If so, it’s best to do what you can to make sure she gets enough formula or breast milk to do catch-up growth.
The Ideal Age for Premature Baby Sleep Training
So what is the ideal age to sleep train a premature baby? The key is corrected gestational age. If the baby were full term, the ideal age for sleep training would be four months of age. Prior to that age, you have laid most of the groundwork already. You’ve learned baby sleep cues, and you’ve started providing structure to the baby’s day. You might not even need to sleep train at this point! If you’re doing premature baby sleep training, you want to aim for four months corrected. For example, if your preemie were born at 36 weeks (4 weeks early), your goal should be five months of age. At this point the baby can be expected, reasonably, to achieve the sleep patterns of a four month old full term baby.
I say “ideal age” for premature baby sleep training, because this is the age at which I believe you’ll have the most success. Four months corrected is about the age when a girl baby can soothe herself to sleep. You can put these girls down in the crib fully awake. And they can learn to fall asleep without assistance. For boys, the age is somewhat later. Certainly by six months (corrected) a boy can master the self-soothing skills needed to settle himself… and to sleep through the night (if he’s well-fed!)
- Premature baby sleep training is just like full-term sleep training, with some exceptions. You need to pay attention to any health issues related to prematurity. And you should lean more towards following her cues.
- Providing structure is still important. Whichever method you choose to sleep train your preemie, she’ll do better if her day is as regular and as predictable as possible.
- Expect a girl preemie to sleep through the night at around 4 months (corrected), and a boy by 6 months (corrected)
- If there are any health concerns at all, please contact your pediatrician.
- If the baby’s health checks out, you still are having sleep difficulties, I can help!