Sleep, Changing Patterns In The Family Bed

Sleep, Changing Patterns In The Family Bed

  • Posted by Dr. Jay Gordon

I can only imagine a mom and dad who are as tired as anyone can be, eager to see this article on sleep, and finding that we had made it unavailable for a little while!

We had to do that because I didn’t write the article clearly enough and need to clarify some very important facts.

It would be hard to find as strong a proponent of the family bed as I am. Yet, I have received email commenting that there were sections of this “plan” which were easy to misinterpret as being just another angle on “sleep training” for young babies. It is not meant to be that. Not even close to an endorsement of the benefits of getting your baby to “soothe herself to sleep” during the first year.

Here’s what I really want to do: I want to offer an alternative to Ferber and Weisbluth and the Whisperer. I never want to see my ideas applied to a four month old or even a seven month old baby. As a matter of fact, I am not too excited about pushing any baby around at night but I know that sometimes it will be done and I’d like to offer a gentle, supported plan for after the first year.

Before I go any further, let me express my overriding concern. Babies do better when we answer all their questions as best we can and meet their needs as best we can.

Most of the families I have taken care of in my pediatric practice sleep in a family bed.

Their babies tend to breastfeed for more than one year and they don’t sleep through the night any better than most of us would if we napped and cuddled within inches of the best restaurant in town and knew it was open 24 hours a day.

This arrangement is not just adequate and tolerable, but actually feels easier to moms who can just roll over, nurse a while and fall back to sleep with their babies rather having to get out of bed to nurse or, alternatively, refuse to nurse and get their babies back to sleep some other way.

Lots of parents continue this pattern through the first year and well into the second and beyond, but some get tired of it — or just plain tired — after a while and are looking for a way to change things. Saddest of all, some moms and dads think that total weaning from breastfeeding is the best way to get more sleep. They choose not to look into nighttime weaning as a good option instead.

There are dozens of confusing books and magazine articles implying that there can be some quick and easy way to get your baby to sleep or to not nurse through the night. I have yet to read one which told parents the complete truth: It’s not easy, it’s rarely quick and it’s usually a little loud and heartbreaking for a few nights . . . or more. I have seen too many families needing help and getting offered choices they didn’t like at all.

I have a better alternative to completely weaning or to letting the baby cry it out. Babies wake up for the optimal interaction with their moms, breastfeeding back to sleep. If we offer them a little less than that for a few nights and then a little less and still less in the ensuing nights, gentle behavior modification will lead them to realize that it might not be “worth it” to knock on the door of a closed restaurant, so to speak.

I don’t recommend any forced sleep changes during the first year of life. Probably the only exception to this would be an emergency involving a nursing mom’s health. There are many suggestions in books and magazines for pushing “sleeping through the night” during a baby’s early months or during the first year. I don’t think this is the best thing to do and I am quite sure that the earlier a baby gets “non-response” from parents, the more likely he is to close down at least a little.

Don’t get me wrong. I love the family bed, child-led weaning and cuddling all through the first, second, third year or more if it’s working well and if the family is doing well. Don’t let anyone convince you that this is a harmful choice or that there will be “no way” to get him out of your bed if you don’t do it now. Don’t believe anyone who says that babies who cuddle and nurse all night long “never” learn to self soothe or become independent. This is simply nottrue but it sells books and the myths stay in our culture.

Some moms just don’t want to do this after some months or years and there should be a third choice to the dichotomy of crying it out or giving in to all-night nursing. Again, I support the family bed and frequent night nursing for a long time and even attempt to pull some parents along “just a little farther,” but I often have to switch tacks and support and help families with difficult choices.

Here’s what I recommend for older babies:

Choose the most valuable seven hours of sleep for yourselves. I personally prefer 11p.m. through 6 a.m. but you might have a slightly different idea.

Change the rules during those hours and be comfortable that a “well-built” family bed baby’s personality can withstand this rule changing and the mild inconsistency of getting everything he wants all the time . . .oops, almost all the time. That’s the word we want to show this baby. The word “almost.” If only we could explain to him that “tired moms and dads take their children to the park a little less and that children of well-rested parents get to go the zoo and for hikes a lot more than children of exhausted parents.” If that explanation only made sense to kids somewhere before the third birthday (and it doesn’t!) they would simply roll over, say, “See you in the morning,” and let us get the sleep we want.

I try to do this in three- and four-night intervals.

I’m assuming that you have a wonderfully healthy 12-, 15-, 20- or 30-month old baby who still loves to wake up every 2 to 4 hours to cuddle, eat or . . . whatever. I’m assuming that you have thought this through, decided you want to make changes and alerted the neighbors that it might be a little noisy for a week or so.

I’m assuming that both parents agree — or almost agree — that this is the best thing to do. And, most important assumption of all, you are willing to go “in a straight line” to the goal of seven straight hours of sleep.

The reason for that last statement: If your baby learns that crying, squirming and fussing (euphemisms, let’s just say “crying” . . . sorry) for an hour will get him fed you will set yourself back quite a bit. This is the best program I have seen but it’s far from easy. And now, to say it again, I really like what you’ve been doing. Cuddling, nursing, hugging through the night. Don’t change this with my program or any other if you’re happy doing what you’re doing. But . . .

The First Three Nights

At any time before 11 p.m. (including 10:58) nurse to sleep, cuddle and nurse when he wakes up and nurse him back to sleep, but stop offering nursing to sleep as the solution to waking after 11 p.m.. Instead…..

When your baby awakens at midnight or any other time after 11 p.m., hug him, nurse him for a short time but make sure he does not fall asleep on the breast and put him down awake. Rub and pat and cuddle a little until he falls asleep but don’t put him back on the breast (or give him a bottle if that’s what you’ve been doing). He must fall asleep with your comfort beside him, but not having to nurse to feel comforted enough to drift off.

Now, he will tell you that he is angry and intensely dislikes this new routine. I believe him. He will also try to tell you that he’s scared. I believe he’s angry, but a baby who’s had hundreds of nights in a row of cuddling is not scared of falling asleep with your hand on his back and your voice in his ear. Angry, yes. Scared, no, not really.

During these first three nights, repeat this pattern only after he has slept. He might sleep for fifteen minutes or he might sleep for four hours, but he has to go to sleep and reawaken to get cuddled and fed again.

These will be hard nights.

You may have decided you’re really not ready to do this. That’s OK. Stop and start over again in a few months if you like. Choosing the right time is crucial and many people choose a time suggested or pushed by friends, doctors or in-laws. This doesn’t work as well.

Is it better to do this in the family bed, a crib in the same room or using a crib in another room? I prefer to continue the family bed even though it might seem harder at first, but it has always seemed harder to me to be putting a baby in and out of a crib. However, a crib or toddler bed in your room may be what works best for you. Another option is to expand your bed’s limits by placing another mattress against your mattress. A bit more space for each family member may help to solve some of the sleep issues. My least favorite choice is a crib or bed in a separate bedroom.

Again, during these first three nights, between 11 p.m. and 6 a.m., cuddle and feed short, put him down awake, rub, pat, talk until he falls asleep and repeat this cycle only after he’s slept and reawakened. At 6:01 a.m., do whatever you have been doing as a morning routine ignoring the previous seven hours’ patterns. Many babies will roll over, nurse and cuddle back to sleep and give you an extra hour or so. Some won’t.

For me, one of the most reassuring parts of this “sleep plan” is seeing that babies wake up fine, happy and grudge-free about the change in the rules. You’ll see what I mean, even if the first few minutes of the morning are not exactly as they’ve always been.

The Second Three Nights

Again, the nursing to sleep stops at 11 p.m. When he wakes up, hug him and cuddle him for a few minutes, but do not feed him, put him down awake. Putting him down awake is a crucial part of this whole endeavor because it really does teach him to fall asleep with a little less contact and then a little less. Not feeding is the big change during these three nights. One-year-old babies can easily go for those seven hours (or more) with no calories. Theylike to get fed a little through the night, but physiologically and nutritionally, this is not a long time to go without food.

If I could wake my wife a few times each night, ask her to squeeze me a little fresh orange juice (my favorite drink) and rub my back while I drank it, I wouldn’t choose to voluntarily give up this routine. My wife might have some different ideas and get tired of the pattern quickly. Babies rarely give up their favorite patterns and things — day or night– without balking and crying.

I really don’t like listening to babies cry. I actually hate listening to babies cry. Unlike them, though, we adults can truly understand the implications of lack of sleep for a family of three, four or more people. Sleep patterns sometimes have to be changed. The incredible safety and reassurance the family bed has provided, and continues to provide, supplies the best context and location for these changes.

During these second three nights, some babies will cry and protest for ten minutes at a time and some will go for an hour or more. Your toddler is aware that you are right beside him, offering comfort and soothing. It just isn’t the mode of comfort he wants at the moment. It is hard to listen to him fuss, but it will work. I believe that a well-loved baby, after a year or more in the family bed, will be the ultimate beneficiary of his parents getting more sleep. Not coincidentally, the parents benefit “big time,” too.

“Yes, for the past many months we have enjoyed voting “1 to 2″ — non-democratically — in favor of . . . the baby. ‘Anyone want to get up all night, feed and walk the baby and be really tired all day and the next day too?’ Well, the vote is 1 to 2 in favor of the baby.”

Now, what we’re saying is, we will sometimes be voting two to one in favor of the baby’s family. This “baby’s family” concept may be abhorrent to he who considers himself the King of England, or Emperor of the Whole World, but our knowing he has that feeling of power allows us to confidently demote the dictator to a majority-respecting member of the family. His family.

By the end of the sixth night, your baby is going back to sleep without being nursed or fed. He’s going back to sleep after a nice hug, a cuddle and with your hand on his back and your words in his ear.

If, at any point this is feeling “wrong” to you, stop, wait some months and start over. Don’t go against your “gut instincts” which tell you that this is the wrong time to get longer sleep intervals from your baby. Your instincts are better than any sleep-modification program ever written.

The Next Four Nights

Nights seven, eight, nine and ten. Don’t pick him up, don’t hug him. When he awakens after 11 p.m., talk to him, touch him, talk some more, but don’t pick him up. Rub and pat only. No feeding either, obviously. He will fall back to sleep. Repeat the rubbing and talking when he reawakens. By the end of the ninth night, he will be falling back to sleep, albeit reluctantly for some babies and toddlers, with only a rub and a soothing voice.

After

After these first ten nights, continue to cuddle and feed to sleep if you like and he wants to, but do nothing when he wakes up except to touch a little and talk to him briefly. This may continue for another three or four nights but occasionally keeps going for another week or more. Then . . . it stops. He has learned that he is just as well-loved, gets virtually everything he needs and wants all day, but must give seven hours per night back to his parents and family.

What happens if you travel, he gets sick or some other circumstance demands a return to more nighttime interaction? Nothing. You do what you need to do (cuddle, nurse, walk, in the middle of the night, as many times as you need to) and then spend a night or two or three getting back to the new pattern the family has established.

By the way, pay the baby. Make sure that he really does get a lot of the benefit of your getting a good night’s sleep. Go to the park more often. Do all those things with him you said you’d do if he ever let you sleep longer. Explain it to him as you’re doing it. He’ll understand in an ever increasing way and will be OK with all this.

191 Comments

  1. Teresa

    I recently had to start a full-time internship after being a full-time stay at home mom to my 13 month old son. He was down to 2 nursing sessions/night before I started working, but now, of course, he is waking 4-5 times per night again to nurse back to sleep (we co-slept for the first 6 months and then transitioned him to a crib in his very nearby bedroom). I have arranged my schedule so that I can be with him from 4pm until bedtime (730 or 8) each weeknight and all day on Sat & Sun. I want to allow him time to adjust and give him as much cuddle time with me as possible, but after 13 months of sleep deprivation and a recent minor car accident, we consider it imperative that better, longer sleep becomes a higher priority in our home. I think I could handle 1 waking, but I'm not sure how to adjust the above plan to accomplish that. I suppose 1 waking waking could be encouraged just before 11pm. Do you have any other thoughts or suggestions? Thank you.

    1. Cheryl Taylor

      It's a tough adjustment when Mom goes back to work both for Mom and baby! I would expect it to take a little bit of time to make that adjustment. Your idea of waking him to get a good nursing before you go to sleep is a good one. I would also encourage you to cluster nurse between 4p and 7:30p, nursing at least every hour. This may help him both with the need to nurse and the change of your constant availability.

      When you are home for the weekend is there a morning that you can go back to sleep after the first morning nursing and let someone else take him for a walk or out of the house and get a couple of hours of solid sleep? A couple of hours of sleep without that sense of listening for the baby can give you the boost that you need to combat the exhaustion. At least temporarily this may help you get over the transition period.

      Hope that helps.

  2. Katherine

    Thanks in advance for taking the time to update the Library Links on the subject of breastfeeding and tooth decay. Our 11-month old has cavities on the back of her upper front teeth, and two dentists (one pediatric) have told my partner to stop night-nursing. But we don't want to stop our baby from nursing on demand, during the day or night.

    Anyway, what struck me was that when I mentioned that the most recently published studies in peer-reviewed journals conclude that evidence for the link between night-nursing and tooth decay is inconclusive, neither dentist knew what I was talking about. I'm a bit disturbed by the fact that my dentists are making recommendations based on outdated research. An updated Links Library is most welcome!

    1. Cheryl Taylor

      I'm equally disturbed at the general lack of accurate information regarding breastfeeding in pediatrician's offices. Sadly this doesn't surprise me. I suggest taking some of that current study information to those dentists. :)

      I hope to have the updated Link Library up by August.

  3. Brooke

    THANK YOU THANK YOU THANK YOU from a little town in New Zealands south island. I have recently separated from my partner and baby's father and right from her birth i have coslept with her and loved it had mixed reactions from family members etc and at the end of the day all told them to get stuffed. I am now going to be returning to work in a month's time and now after reading your amazing article feel so much better about it and will continue to breast feed my daughter it is so good for her after her rough year to be able to snuggle down and have some "boob and snooze" time with me. And also after reading your article i feel so much better and can really tell the critics that say give it up to really get stuffed!

  4. Marilee

    Hi, Like everyone else, I am so glad to have been shown this website. My son is 13 months old and recently we have been doing a combination of crib/cosleeping. Wherever he is his waking is essentially the same – about 6-10 times per night and nothing less than nursing is what he wants. I like that your plan allows me to still nurse him to sleep and for naps, and only change the part that I just can't do anymore (mostly due to my loss of sanity) – the endless nursing in the middle of the night.

    Here is my question – it says to make sure to put him down awake – Often when he "wakes up" he is sitting up screaming but with his eyes closed. I've tried soothing him without nursing and he just thrashes around and does not want to be cuddled with. When I put my breast in his mouth he instantly calms down and stops moving, and sometimes does not even begin to suck for maybe 20 seconds, but if I remove my breast he immediately begins crying again. Not every wake up is like this, but at least twice a night it is. How would you recommend handling it? My thought is just to let him nurse until his breathing has calmed and then unlatch him, but that either results in A. screaming (which I can handle if needed) or B. he is already asleep.

    Here is question #2. Like I said he does not want to be cuddled when he is trying to nurse and I'm not nursing him. He pushes away and cries. We have tried doing this in our bed and it really is hazardous. There is no way I can play asleep. He thrashes around, sits up, then flings himself down to the bed, once giving me a fat lip with his head, and often banging my face, my breasts, sometimes hitting his head hard on the wall. So, I have to keep pulling him down to a laying down position, which is not easy considering he is 32+ pounds, and just not very gentle or soothing. So, I've decided it has to happen in my arms in the chair in his room, and I'll lay him down in the crib and then sleep on the floor next to him. It is hard to do it in my arms, but better than laying down, and I don't want him to have to cry in the crib without me. Do you have any better suggestions? But then what do I do during nights 6-10? Do I just stick with the day 4-6 routine until he can be in the crib without crying? Or do I bring him back to the bed and see if we can do the night 6-10 routine there? I'm sorry this is so long! I really appreciate your taking the time to answer! – a deliriously sleepy mom.

    1. Cheryl Taylor

      I understand the thinking that lying down awake is part of teaching them to go to sleep on their own, and that it could be valuable for some children, but I personally taught night time weaning to my own children including nursing to sleep. I think that you can teach night weaning and still teach them that they can nurse to sleep and for a nap.

      It can be very tricky with a just turned one year old. Some of them are ready to night wean and it happens pretty easily, but some just aren't ready and it becomes a battle. You are the only one that knows if he is at a place where he could learn that night time is for sleeping. It sounds like he doesn't even completely wake up and you're dealing with a toddler that is functioning on the natural infant instinct to nurse when they wake. Have you considered using a small mattress next to yours to teach night time sleeping? It works well for some because they have their own space to thrash around in and can learn to lie still and nurse when lying over by Mom and then roll over onto their own space when done. It might be something you want to consider.

      When you're making progress with night weaning definitely adjust the suggestions as you feel would be best for your own baby. You are the one that knows when your baby is ready to move forward more than anyone else. The same applies to nursing to sleep. If you know your baby needs to nurse to sleep and learn night weaning pertaining to those times when he wakes after going to bed until it's light outside, then adjust it to your baby's needs.

      Hope this helps.

  5. Jonna

    Hi. My daughter is currently 20 months old and I am 7 months pregnant. For the first 15 months of her life we coslept in the bed with my husband. Up to that point she had never slept more than 3 hours in a row and I was very exhausted. The only way I had ever put her to sleep was by nursing, so my husband couldn't help with naps, bedtime, or wakeups. We finally decided to night wean when I found out I was pregnant. She was currently going through a spell of waking almost every hour; I also had morning sickness all day (and night) and just couldn't cope any more. At that point my daughter and I were sleeping in a separate room on two mattresses on the floor. I found Dr. Gordon's advice helpful and followed his recommendations. It took my daughter over three weeks to adjust to the new schedule, but as soon as she did she started basically sleeping through the night. Unfortunately, the only aspect of his plan that she never took to was the idea not to nurse until 6am. She wakes up at 5am (if I'm lucky, 5:30), no matter what time she goes to bed, and wants to nurse and then play. Nothing works to get her back to sleep and she will cry until she nurses. When she moved to one nap I noticed she was getting sleepy and crabby in the late morning. If I put her down then, she sleeps through lunch and generally won't take another nap, which means an even earlier bed time that her usual 6:30-7:30, so I try to hold her off until after noon. My milk dried up a couple months ago, now it's basically comfort nursing, but I'm worried about what will happen when/if my milk comes in and she starts getting the real thing again. I don't want to tandem nurse, but I don't want to traumatize my daughter by completely cutting her off if she isn't ready. She generally nurses when she wakes, for nap, and for bedtime, but I've begun giving her a countdown and just laying next to her until she falls asleep. As far as her waking goes, the room has a blackout curtain and the seasonal time change had no effect. She still woke at 5. My husband is going to start trying to put her down at night and sleeping next to her. I guess my question is how to help her sleep habits evolve into something more flexible. She will need to learn to go to sleep either alone, or with someone else, and with a new baby coming, I'd really like her to sleep past 5. Thanks so much for your time.

    1. Cheryl Taylor

      The idea of teaching her to lie down and sleep with your husband is a very good idea, as it will give you another piece of night weaning. It will also help to foster her feelings of having something special with her Daddy, which will help when she’s adjusting to a new sibling. I would make it a point to do things especially with her when your newborn is asleep or being held by someone else.

      Some children….some people really!…are just not flexible when it comes to their sleep cycles. She may be an early riser and there may not be anything you try that ever changes that. However, you can teach her different habits. She can learn that if she wakes up early her options are to read quietly in bed or quietly play with a doll or stuffed animals but stay in her room.

      I think the biggest key to making changes with an almost two year old is to talk about it with her at a time during the day (and several times per day!) about what you expect and how things are going to go that evening and morning. Talk talk talk about it with her. It’s almost as if describing in advance what she needs to “see” happening. With a little time she will then make it happen. Praise her HUGEly for every little step in the right direction…again…during the day when she’s at her best.

      Hope this helps and congratulations on the new baby on the way!

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