Definition

• A baby over 6 months old who can’t sleep through the night (at least 7 straight hours)
• Wakes up and cries one or more times a night to be fed
• Can only return to sleep if you hold and feed him
• Sometimes called a trained night feeder

Health Information

Cause of a Trained Night Feeder

• The main cause is being breast-fed or bottle-fed until asleep at bedtime and for naps.
• If the last memory before sleep is sucking the breast or bottle, the child does not learn to comfort himself and fall asleep without the breast or bottle.
• Therefore, when the baby normally wakes up at night, even though he’s not hungry, he is not able to go back to sleep without feeding as a pacifier. All children have 4 or 5 normal wake-ups per night at the end of each sleep cycle.
• Age limits how long a baby can fast. As babies become older, they can normally sleep longer without a feed.
• By 4 months of age, most bottle-fed babies can sleep 7 hours without a feeding.
• By 6 months, most breast-fed babies can sleep 7 hours without a feeding.
• Normal children of this age do not need calories during the night to stay healthy.

Care Advice

1. Separate Feeding from Falling Asleep:
   • All sleep re-training starts at bedtime and naptime.
   • Feed your baby as the first step in the bedtime ritual, rather than the last step.
   • Also, feed him in a different room with the lights on.
   • Your baby’s last waking memory needs to be of the crib and mattress, not of the breast or bottle.
   • The best sequence is feed, read, bedtime ritual, then put in crib.
2. Put Your Baby in the Crib Drowsy but Awake:
   • At naptime and bedtime, place your baby in the crib drowsy but awake.
   • This is when you need to re-train your child to be a good sleeper.
   • Start with a pleasant bedtime ritual. But when your baby starts to look drowsy, place him in the crib.
   • Your child’s last waking memory needs to be of the crib and mattress, not of you.
   • If your baby is very fussy, rock him until he settles down or is calm, but stop before he’s fully asleep.
   • He needs to learn to put himself to sleep. Your baby needs to develop this self-comforting skill so he can put himself back to sleep when he normally wakes up at night.
3. Visit Your Baby for Crying:
   • If your baby is crying, visit him as often as needed until asleep. This is part of sleep training.
   • Make the visits loving, but brief.
   • Don’t stay in your child’s room longer than 1 minute.
   • Act sleepy. Whisper, "Shhh, everyone’s sleeping." Add something positive, such as "Love you," or "You’re almost asleep."
   • Do all of this in a loving way with a calm, soft voice.
   • Try not to show any normal anger or frustration during these visits.
   • Return every 5–10 minutes. Gradually lengthen the time between your visits.
4. Once Placed in the Crib, Do Not Take Out Again:
   • Naptime and bedtime are the best times for sleep training.
   • Do not give in. Do not play with your baby or bring him to your bed.
   • Even with your visits, most babies fuss and cry 30 to 90 minutes before they fall asleep.
5. For Crying During the Middle of the Night, Temporarily Hold Your Baby Until Asleep:
   • Until your child learns how to put herself to sleep at naps and bedtime, make the middle-of-the-night wakings as easy as possible for everyone.
   • If he fusses for more than 5 or 10 minutes, go in briefly and reassure him.
   • If he cries longer, take your child out of the crib and hold him until asleep. You don’t have to do sleep training in the middle of the night.
   • But don’t take him out of the room, entertain him or talk to him very much.
6. Provide a Nighttime Feeding Only if Last Fed 5 or More Hours Ago:
   • Any healthy 4 month old baby can fast that long.
   • Make this nighttime feeding boring and brief (no longer than 20 minutes).
   • Stop it before your child falls asleep, and replace it with holding until asleep.
   • Stop giving your baby any bottle in bed. If you feed your child at bedtime, don’t let him hold the bottle.
7. Gradually Lengthen the Time between Daytime Feedings to 3 or 4 Hours:
   • You can’t lengthen the time between nighttime feedings if the time between daytime feedings is short.
   • If a baby is used to frequent feedings during the day, he will get hungry during the night.
   • Phase out any comfort feeding or grazing.
8. Last Step - Phase out the Nighttime Feeding:
   • Phase out the nighttime feeding only after your child can put herself to sleep without feeding.
   • Grazing must also be gone and the time between daytime feedings must be more than 3 hours.
   • Gradually phase out the last nighttime feeding over 2 weeks by gradually reducing the amount.
9. Prevent Baby Bottle Tooth Decay:
   • Severe tooth decay is the most serious side effect of poor sleep training.
   • Never give your baby a bottle of milk or juice in the crib. Same goes for sippy cups.
10. What to Expect:
    • Be consistent and you will see improvement within a week.
    • Expect some crying during the transition.

Call Your Doctor If

• Your child is not gaining enough weight
• Crying becomes worse after 1 week of this program
• Your child is not sleeping longer after you try this program for 2 weeks
• You have other questions or concerns

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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