During the extreme fussiness period, your child has learned to associate falling asleep with very specific behaviors such as extended rocking, walking, hugging, and feeding. She comes to expect this attention when she drifts off to sleep. The process of falling asleep is learned behavior. She may never have learned to fall asleep by herself. She may be, in a sense, addicted to social interaction in order to fall asleep. When older, after three or four months of age, some of these babies develop an over-tired state because they are receiving less of this soothing attention or the parents fail to establish healthy sleep habits. So even after the physiological causes of the crying (whatever they are) have abated, the old fussy pattern might remain.
Parents, too, become conditioned after several months of coping with extreme fussiness. They have frown used to lavishing prompt, continual attention on their crying baby. The variable nature of extreme fussiness has taught them to shift strategies frequently. They have become improvisers-trying what worked last night, trying what worked this morning, or trying something new. It has never been practical for them to have a plan; they just responded. However, a baby who once was extremely fussy needs consistent, thought-out management to curtail bad habits. Parents must make a transition, too.
A Gradual Approach
I would like to describe a gradual approach to be tried in infants three, four, or five months old, right after the extreme fussiness seems to have eased. These are sensitive months in the development of a baby's crying and sleep patterns. In infants under three to four months, crying comes directly out of biological needs-for food and fluid, dry skin, contact and comfort, and in the case of extreme fussiness, for relief from the unknown causes. Babies this young will not be spoiled or taught bad habits by your response to their crying. Infants over four to six months old, by contrast, can indeed learn to cry in order to get their parents to do certain things. They have learned to cry for attention. And they may have learned how to keep themselves from falling asleep. These interim ages-three to six months- are a time to keep bad habits from forming and a promising time to teach a previously extreme fussiness, potentially sleepless baby how to stop crying and get enough rest. Remember that parents should be teachers!
The "Fade-Out" Procedure
Basically, you will gradually decrease the amount of work you do when you put your baby to sleep. The goal is to let him develop internal resources to fall asleep. At the same time, you will be teaching yourself how to be the parents of a normal baby who does not always need your immediate attention.
Each family is different. Babies become ready at different ages. Please think of these suggestions as general principles rather than rigid rules. But do try to understand the basic theory: gradually, consistently cut back on the elaborate procedure you go through to get your child to sleep, until he is "weaned" from your company, so he can to it on his own.
Step 1: Don't Pick Him Up
Your baby is now three to four months old. His extreme fussiness is not as bad as it once was, but he still awakens frequently at night. Begin by figuring out how often your baby is truly hungry at night. Ask yourself how often he really sucks with enthusiasm. Listen to the quality of the crying-true hunger crying in the older infant had a sound all its own. Calculate how much time passed since the last feeding: if it is less than two hours your baby could not possibly be hungry.
Now that you have decided how often you should feed your baby at night, pick him up and feed him at those times but do not pick him up at any other times. This is the first step: do not pick the baby up unless you are going to feed him.
Do you just ignore his cries? No. Go into his room and sit beside him. Pat him, stroke him, or hold his hand. Let him see you, and let him see you looking at him. Talk or sing. Keep it calm and gentle. Stay beside him as long as necessary, even until he falls asleep. Respond promptly each time he cries- but do not pick him up unless it is time for feeding.
If your baby persists with inconsolable screaming despite your soothing efforts , stop. Go back to what method(s) you were using before. Try this suggestion again in a few weeks. Once you are able to calm him down, and pick him up only for feeding, move on to Step 2.
Step 2: Cut Back on Your Responses
Begin to cut back on what you do as you sit beside your baby. You might give up the eye contact first, keeping the room black and staying out of view. Later, stop rocking the crib or stroking the baby. Go slowly and see what works. the goal to be reached after a week or two is to reach the stage where you are merely resting your hand on the baby's back or quietly holding his hand. You still respond promptly and take as much time as necessary to lull him into a deep sleep. Pay attention to how much time this usually takes, and proceed to Step 3.
Step 3: Spend Less Time
Try to reduce, by a minute or two at a time, the amount of time you sit with your baby. Respond promptly, but slip away a little sooner. If you find that he startles and cries when you leave, go right back in. After several days or a few weeks, you may find that just putting your hand on his tummy or back for a few minutes magically induces sleep. That will be a good accomplishment: You will have loosened the connection your baby used to make between long, complex social interactions and falling asleep. Now he may do it with only a quick reassurance of your presence.
Step 4: Wait A While
Now, for the first time, wait a bit before you go to the baby. Give him a chance to settle down by himself. Do not wait so long that a full-crying storm develops, for then he will need a lengthy calming down. Wait two or three minutes to start, wait longer when you feel you can. Learn to recognize the drowsy, testing cries and wait them out. Your reward will come on those nights when you hear a call, some whimpering, a faint cry, and then silence.
Will It Work?
You need not take all these steps. If, for example, you had success with Steps 1,2 and 3, but find that your baby always develops crying fits when you try Step 4 stop where you are. You have already made fine progress. Live with those brief nocturnal visits a few months more until the child outgrows this dependence on your presence. Sometimes this procedure works only when the father responds to the night awakenings and proceeds through Steps 1 through 4.
If this plan does not work at all for you, make sure you and your husband, and whoever else might tend to the baby at night, are all being consistent. You should always know how you plan to deal with the baby at night and you should not give in, for example, pick him up, "just this once". It is also possible that your child is not ready; try again in a few weeks. I cannot predict whether this "fade-out procedure" will work for a particular family, but it is based on tested principles and I feel certain it is worth a serious try.
Focus on the Morning Nap
When three to six months old, try to establish a morning nap. The reason that you will focus on the morning nap is because a regular and long morning nap develops before an afternoon nap. Also, you are more likely to be successful for the morning nap because your baby is more rested in the morning following a night's sleep. Here we go:
First, Keep the entire wakeful period from the end of the night to the beginning of the nap to no more that one hour. This utra-short period of wakefulness helps prevent the over-tired state. Declare when you think the night sleep has ended: 5,6,7 am and then look at your watch. Within one hour you clean, change, feed, and soothe back to sleep. This means that there is no time or little time for playing. If you have bright natural light in your home, exposing him to bright natural light might help. Morning light seems to help set biological rhythms and help regulate sleeping patterns.
Second, after soothing for only several minutes, which may include breast-feeding or bottle-feeding, put you child down in his crib. At this particular moment, he may be asleep, awake, or in an in-between state. You don't care; you put him down. Your custom in the past may have been to always hold him until he was in a deep sleep state because you observed that if you put him down awake or in a twilight state he always cried hard. Now that he is three to six months old, his sleep rhythms are more developed. This means that you can use his natural or internal rhythm as an aid to help him fall asleep. This occurs if, and only if , you are synchronizing your putting down to sleep with the surfacing time of drowsiness. Just as a wave surfaces, the surfer will have a smooth ride only if he has good timing to catch the wave; your baby will smoothly fall asleep if you catch the drowsy wave.
So when you put your baby down, after soothing, sometimes he is not in a deep sleep state. This is the beginning of allowing your baby to develop some self-soothing skills. You are beginning to wean him from the expectation that you will always lull him into a deep sleep state.
Third, when you put him down, if he cries, ignore the crying for 5-10 minutes, maybe less, maybe more. Listen to your heart, is it a loud cry or a quiet whimper. The point is, you do not immediately pick up your baby when he cries. If, after crying, you pick him up, then you have two choices. One. The crying may have been so stressful to you that you go out with your baby for a walk to relax, calm down, and try it again the next morning. Two. Your baby is not falling asleep in your arms because you have picked him up and you decide to put him back down to see if he will stay asleep to take a nap.
Once the morning nap is established, try this procedure for subsequent naps. Keep the interval of wakefulness between the naps to a maximum of two hours. Within two hours, babies quickly become overtired and then it is difficulty for them to fall asleep. The reason that the overtired state messes up good sleeping is that when you are overtired, the body's adaptive biological response to fight the fatigue by producing stimulating chemicals. This 'second-wind' interferes with the ability to fall asleep and stay asleep.
By three to six months of age, your baby will be taking a morning nap that starts between 9 and 10am and an afternoon nap that starts between 12 and 2pm. Each nap will last about one to two hours. The quality of sleep is probably better if it is motionless sleep in these older babies. The movement in strollers, swings, and cars might prevent them from getting the full restorative power of long deep sleep states.