I have finished with my last family and am planning a holiday when I get an emergency call from the agency: a mother with a 5 month old needs help with sleep routines.
When I get to the house at 10am for my interview, I am greeted with joy and relief by Katie who is holding her baby in her arms. We go inside and settle down. I comment on how calm Katie’s baby looks.
“She’s called Ella, and she doesn’t always look like this,” remarks Katie ruefully. “In the middle of the night she can be screaming for up to an hour at a time and often wakes every couple of hours or so. It never used to be like this – I used to be quite smug about how well she was sleeping, but now it has all gone awry and I don’t know what I am doing differently or where the mistakes were.” As she tails off, it is clear that she is on the verge of tears.
“Don’t worry,” I reassure her. “Lots of babies start off by sleeping well, it’s the main occupation of their day and it is so important in terms of their development that they sleep well regardless of any routine or sleep association you might be putting in. So you may think you have a ‘good sleeper’ and you’d be right. But as they get older, and more aware of their surroundings, they can sometimes lose the good sleep habits of the early months.”
“Why does that happen?” Katie asks.
I explain how a baby like Ella can start off her life spending around 18 hours every day asleep, waking up only for a feed. But as they get older, they become aware of the world beyond their immediate desires. They realise there are other people around, people like Mummy who feed them, cuddle them and make them feel secure. They also begin to notice the difference between day and night, awake and asleep, and the transition period between awake and asleep. “We talk about ‘falling’ asleep,” I explain. “And that is what it is like for a baby, that feeling of losing consciousness.”
I often use the comparison with a child using a slide for the first time. Sitting at the top, she is scared to let go. So as her mother, you will hold her and take her down the slide. Gradually as she becomes more confident, you will let her go for a second, then for several seconds and finally she will slide down on her own, loving the feeling because she knows the loss of control is not forever.
Sleep can feel the same. As adults, we embrace that feeling of losing consciousness, we know we are falling asleep and we know it is good for us. But for a baby just beginning to be aware of her surroundings, that falling feeling can be scary. So she will fight it, doing what she can to stay awake and often needing her mother to comfort her through the transition from wakefulness to sleep. “Of course, this generally takes the form of feeding or cuddling her to sleep,” I say, “which means she is no longer self-settling and this is how the bad sleep associations begin.”
“So can you sleep-train her?” asks Katie.
I take a deep breath and embark on a further explanation. “I don’t sleep train babies under six months who aren’t yet weaned.” I tell her. “It may sound pedantic, but I try to draw a clear distinction between sleep training, which is what I would do with a baby of over six months who is fully weaned and still struggling with disrupted sleep, and establishing good sleep habits, which is what I will do with Ella. Although lots of babies do sleep through the night before they are six months, a baby who is having difficulty shouldn’t be sleep trained in the accepted sense of the word.”
“Oh, I get it,” responds Katie. “You can teach her not be afraid of falling asleep, and you can teach her to self-settle, but you wouldn’t deprive her of any feeds to get her to go for twelve hours straight through.”
“That’s right,” I reply. “Good sleep habits can be taught from birth without interfering with a baby’s breastfeeding – there are lots of things you can do to ensure that your baby is learning good sleep habits which will then enable her to sleep well, waking regularly for her feed. But a professional won’t teach a baby to sleep through until the baby is ready, or until she needs to at six months.”
“What is so important about the six month mark?” asks Katie.
I explain that this is the point when babies are currently fully weaned. “This means they are having three meals a day, plus milk feeds, so they are getting sufficient nutrition during the day and don’t need a feed at night. Of course, they may still wake up because their body clock is used to feeding in the middle of the night, but it is no longer a nutritional necessity. In fact, quite the reverse. At this age, a healthy baby actually needs to be asleep for twelve hours straight through in order to develop mentally and physically. Disrupted sleep after six months really does need to be addressed. And unfortunately bad sleep habits tend to beget worse sleep habits – so a baby who is waking early will then begin to wake in the middle of the night once or twice … then three or four times … until finally she is waking at the end of every sleep cycle. All the research points to the fact that bad sleep habits won’t get better without intervention and that to do nothing is much more harmful than to do something.”
“So what should I do with Ella?” Katie asks. “Can you help her, or should I wait until she is six months and then go for the full sleep training process?”
“Well,” I say, “on the basis that you have called me in, you obviously feel the situation needs addressing. I can certainly teach Ella not to be scared of falling asleep and to link her sleep cycles again the way she used to. Then her natural desire for sleep should do the rest, so that she will build on that ability over the next few weeks and when you wean her and she doesn’t need to be fed in the middle of the night, it will happen smoothly and easily. I also think that there’s no reason for you both to struggle with this situation any longer than you have to, because a good night’s sleep is important to everyone.”
“I agree,” smiles Katie. “When can you start?”