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Contented Baby Problem Page

Gina FordEach week we receive a huge number of emails with questions from concerned parents. Because of the sheer volume it is impossible to personally respond to every one we receive. But each week we will choose a selection of the most commonly asked questions for Gina to answer, in the hope of making help and advice on these concerns more accessible to followers of the CLB routines who are not members of the website.

Baby, age 7 months - Waking twice a night

Dear Gina

My baby is 7 months old and, despite introducing solids at 6 months and feeding him at 10pm, he still continues to wake up twice in the night and refuses to settle back to sleep unless I breast feed him. He weighs nearly 17 pounds and is exclusively breastfed. He settles well at all his other sleep times, so I know it is not a sleep association problem. I have been advised that a baby of his age should not need feeding in the night and that I should sleep train him to stop him waking up for night feeds. We did try leaving him to cry a couple of times but he just worked himself up into such a hysterical state that it took a good couple of hours to calm him down again. He breastfeeds during the day at 7am, 10.30am, 2.30pm, 6.15pm, 10pm and then around 2am and 5am in the night. We offer him solids at 8am, 11.30am and again at 5pm. He rarely takes more than a tablespoonful at a time and gets very upset if we try to urge him to take more. In addition he refuses any food that contains protein, which is very worrying.

A: In my books I advise that most babies of your son's age can sleep through the night, provided all their nutritional needs are being met during the day.
Taking into consideration your baby's weight and the amount of solids he is having, I suspect that most of his night waking's are due to genuine hunger and that you cannot realistically expect him to sleep for twelve hours until solids are more established.

On saying this, his feeding three times in the night is probably affecting his appetite for solids during the day, hence the reason he is so fussy about taking solids. When this happens a vicious circle arises of baby needing to feed in the night, because he is not getting enough solids during the day.

Sleep training for this type of problem should never ever be contemplated as your baby is genuinely hungry. What I would suggest is that you gradually reduce the amount of milk that your baby is drinking in the night, which will in turn encourage him to eat more solids during the day.

The first thing I would suggest is to drop the 10pm feed. Because he is waking at 2am and 5am, it is pointless to continue with this feed as it is not helping him sleep a long spell in the night. Consequently it will be most likely that he will wake around midnight and 2am. It is important that when he wakes at this time that you offer him a really good feed and do not restrict the length of time that he is on the breast. A substantial feed should hopefully last him to between 5am and 6am.

As your baby is being fussy about solids I recommend that you work on establishing solids at lunch and tea first. I would advise not giving solids at breakfast until your baby is taking between 5-6 tablespoonful's of solids at lunch and tea.

If your baby is not having breakfast you may have to bring lunchtime slightly forward if he is showing signs of being hungry before the recommended time. With a baby who is being fussy about lunchtime solids this is preferable to giving solids at breakfast. As your baby is still feeding twice in the night, I would suggest that you offer the solids first at lunchtime, followed by a breastfeed. As he is still taking two milk feeds in the night, you do not need to worry at this stage that his daily milk intake is dropping too low. The aim of this plan is to increase your baby's daytime solids, without leaving him to cry with hunger in the night. You will find that once your baby increases the solids he is eating during the day that he should automatically need to breastfeed less during the night.

Once your baby has been happily taking 5-6 tablespoons of solids at lunchtime and teatime for several days, you can start to introduce small amounts of protein into your baby's food. When your baby is willingly having 5-6 cubes of protein-based meals at lunchtime, then you can introduce breakfast. I would suggest that you start off with a small amount of yoghurt and fruit, then progress onto breakfast cereal and fruit.

The important thing to remember, when introducing breakfast, is that you should not increase it so much that it takes away the appetite for lunch. Also it will really help if your baby has finished all of his milk and solids by 8am. Remember that the aim of solids is to establish your baby on a feeding pattern of three meals a day with bigger gaps between meals. If you give milk at 7/7.30am and then delay breakfast until 8/8.30am it could affect your baby's appetite for lunch.

Once breakfast is introduced I would count the 5/6am breastfeed as his breakfast milk and reduce the amount of milk that he has at 7am, to encourage him to take his solids well. This is obviously difficult to work out if you are breast-feeding, but offering a few minutes less on the breast, then solids, then the remainder of the breast-feed, should help you get the balance right.

Once your baby has increased the amount of solids that he is taking during the day, he should automatically start to sleep a longer spell at night, where you will find him waking somewhere between 3/4am, instead of 2am and 5am. I would continue with giving him a big enough feed at this time, until he sleeps regularly to 7am for at least a week. Once he is doing this you can gradually decrease the length of time his is on the breast by a couple of minutes every few nights. Once you reach a stage of him taking a breastfeed of only a few minutes in the night and sleeping until 7am, then you can look at dropping this feed, confident in the knowledge that the waking is not due to genuine hunger.

I would suggest that dropping this feed would be easier if you can ask your husband to go to the baby when he wakes and settle him with a small drink of cool boiled water and a cuddle. It may take several nights of your husband having to pick him up and resettle him several times. Follow the same procedure until your son shows signs of settling back to sleep quicker in the night. Once this happens your husband should progress to settling your son back to sleep without taking him out of his cot. Although it may take a week or two, by being persistent and consistent you should get your son sleeping through without resorting to leaving him to cry for lengthy periods.

As you decrease the time on the breast in the night, it is important to remember to allow your son more to drink during the day. What you are aiming for now is a full breastfeed at 7am, followed by solids, then lunchtime solids at around 11/12 noon, followed by a breast feed. At this stage he will need a further breastfeed at around 2.30pm, followed by solids and a small breastfeed at 5pm, then a full breastfeed at bedtime. Once your baby is well established on three solid meals a day and four to five good breastfeeds, you can feel confident that any waking's in the night are not due to hunger.

I would also suggest that you have a discussion with your health visitor about the types of foods that you give your baby. Getting the right balance of protein, carbohydrates, vegetables and fruit also play an important role in establishing healthy sleep habits.

Finally, it is important to keep an eye on how much sleep your baby has during the day. Although all babies are different and some will need more than others, I would recommend that you aim for a nap of no more than 30/40 minutes in the morning and two hours after lunch, if you want your son to sleep well at night. If he sleeps less than two hours at lunchtime, then he may need a short catnap between 4pm and 5pm to avoid overtiredness.

Baby, age 7 months - Early morning waking

Dear Gina

My daughter, age seven and half months, has begun to wake up earlier and earlier. This last week it has been around 5.30am every morning. I have tried leaving her to cry, but she works herself up into such a state that it wakes my toddler up. She eats really well and sleeps well for an hour between 9am and 10am and two hours from 12 noon. She used to go to bed at 7pm but since the early-morning waking I am having to put her down around 6.30pm as she is so tired. With a toddler of eighteen months I am struggling to cope with such an early start.

A: All babies are different in the amount of sleep that they need and I think that your daughter is just one of those babies that probably needs slightly less sleep. Leaving a baby to cry at this time in the morning rarely works, in my opinion, and usually just enforces the early-morning waking even more. It is better to get to the cause of the early-morning waking and, in your daughter's case, I think that the early-morning waking is being caused by too long a morning nap. I would advise that this nap needs to be cut back to around 20/30 minutes and that both the morning nap and the lunchtime naps must be moved on. The morning nap should be moved on to 9.30am and the lunchtime nap moved on to 12.30pm.

In order to shift the morning nap on and reduce it to 20/30 minutes your daughter needs to sleep to nearer 7am. Therefore, it is important that for a few days you feed her immediately when she wakes at 5.30am to help settle her back to sleep.

Once she is settling back to sleep, you can move the morning nap on by five or ten minutes every couple of days until she is going down to sleep at 9.30am for 20/30 minutes. At this stage you should also push the lunchtime nap to 12.30pm and allow no more than two hours, making a total daytime sleep of no more than 2 and a half hours. If, for some reason, your baby sleeps less than two hours at lunchtime, you may need to give her a short nap between 4pm and 5pm, to avoid overtiredness. It is also important that you count any sleep after 7am as part of her daytime sleep allowance. If she sleeps even 10 or 15 minutes past 7am reduce the morning nap to 15 minutes. Once you have moved on your daytime naps, your daughter should manage to get to nearer a 7pm bedtime.

By reducing the morning nap and shifting the naps on your baby should start to sleep later in the morning and the 5.30am waking will naturally disappear but until this happens I would continue to quickly settle her back to sleep with a feed. This solution is preferable to her getting into the habit of being awake from 5.30am every morning.

Which Yoghurt

Dear Fiona

I am about to introduce my daughter to yoghurt for the first time. In the weaning book Gina suggests offering yogurt with mashed fruit, but there are so  many different ones on the markets for babies, I don't know which one would be best as so many of them have sugar or  fruit juice or fruit puree in them. I've bought 'Yeo Valley Organic' bio live yogurt which has no added sugar and a tiny amount of sodium. Is this all right? I'm sure it must be but I'm just looking for some reassurance!

A: I think most of us look for some reassurance when we're choosing foods for our babies, even dieticians! This is especially so when we choose a food like yogurt that our child may eat nearly every day. Yogurt is a great source of body-building protein, as well as vitamins, such as vitamin B2, and minerals, including calcium of course.

There are a lot of yoghurts specifically marketed at children, often in cute child-size containers. While some of these are good choices, they can be higher in sugar than if you mix fruit purée with natural yoghurt. The other issue with these yoghurts is that they are significantly more expensive than the equivalent adult yoghurts that come in larger containers. So my suggestion is to save the 'child-size' yoghurts for weaning (they are a good size for learning to use a spoon, as they can be easier for children to scoop from than a bowl) or for a special treat - a yoghurt with Thomas the Tank Engine on it will make a much healthier treat than a chocolate or sweet. For everyday use, buy plain or natural adult yoghurt - organic is not a necessity, but is a good choice if it is affordable. Depending on your child's age, add either puréed fruit of your choice or a soft un-puréed fruit such as berries, banana or fruit tinned in juice, mashing the fruit a little to allow the juices to sweeten the yoghurt. This has the great advantage of allowing children (so long as they are old enough to manage lumps) to get accustomed to yoghurt containing pieces of fruit, so they won't complain about 'bits' in yoghurt and insist on smooth yoghurt.

A couple more tips - yoghurt is unlikely to contain more than a trace of sodium or salt, but it is always good to check the label (see below for more on this). However, if you buy flavoured or sweetened yoghurt (and this includes the vanilla types), it is likely to contain artificial sweeteners. These are not suitable for young children, so do watch for names such as aspartame, sucralose, Splenda and saccharin in the ingredient list.

Fiona Hinton
Dietician and Nutritionist


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Check out Gina's blog post about Early morning waking and going from two naps to one nap a day.

 

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