WebMD Live Events Transcript

Does your 4-month-old think 3 a.m. is play time? Is your toddler refusing to take a nap? Are you frustrated and fascinated by your infant or toddler's sleep (or non-sleep) habits? Tracy Hogg, the Baby Whisperer, joined us with advice on how to handle your infant and toddler sleep issues.

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician.

Moderator: Today we are going to focus on sleep issues. Our guest is Tracy Hogg, RNMH, MS.

Hogg: They are most common and not as difficult to fix as people think. What happens is when you are sleep deprived, you can't see light at the end of any tunnels!

Member: My son is 21-months-old and wakes up very often screaming. He has [done this] for many months. Even when he is just rolling over, he lets out a scream, and I don't think he's even awake. He's just a very restless sleeper. Any ideas?

Hogg: Is he sleeping independently and in his own bed?

Member: Yes. He is in a crib. The first few months of his life I did have him with me a lot. But I stopped that some time ago.

Hogg: Very often children will make noises or cry out, shout, and be vocal in sleep. As we get older, this can transition into adults talking in their sleep. Adults even wake themselves when they are asleep by laughing and talking. If it were night terrors, they'd be in a standing position. So it doesn't sound like night terror. If he's still sleeping, then it's obviously his way of vocalizing when he's dreaming.

One of the things moms can do to prevent children from becoming frightened at night is to limit television time. Very often the television is on in the background and we don't think that children are aware of what's happening on the TV, but sometimes they are, and it can disturb them. So it's being aware that children of this age are like little sponges and are taking in everything from their environment including the bad with the good. And this can often be seen at night when they are waking up.

When children are younger (under 18 months), it's the physical motion of walking, running, falling over, that tends to be associated with night terrors, not recollection of the day's events. So there's a big difference between what a baby and a toddler experience.

Member: My 7-month-old son breastfeeds and co-sleeps with us. I have two problems -- I can't get him to sleep in the crib, and he wakes up two, sometimes three times in the middle of the night. The only way he will fall asleep again is by sucking. We have tried early on to get him to take the bottle, but he has always refused. How do I wean him off the breast so that he will take a bottle, even if it's breast milk, and how do I get him to sleep in the crib?

Hogg: At this age he should be making the natural transition from milk to solid food and there should be no night feedings. I would be more inclined to introduce a sippy cup than a bottle at this age. Also, when he starts to stop feeding through the night he will take more calories in during the day. Making him more independent in sleep, especially at this age, will take a plan.

For the next week, plan to sleep in his room with him on an inflatable mattress. When he wakes, calm him down, hold him, sit with him, and lie with him, but do not feed him. You will need a lot of support because he will want to feed and you will be tired. Trade off with your husband if he's willing. If not, seriously consider getting a friend or relative to help you out. After the first week, you can start to put him into the crib and follow the pick-up and put-down process described in the book. Some key points:

This is not an easy process.
This takes commitment and patience and a lot of TLC of the parents.
You don't need to be militant or unkind, but just consistent when picking him up and laying him back down in the crib.
Again, get support and change your own mindset of thinking, "Poor baby, I'm taking something away." But rather, "I am giving you a skill."

And there will come a point in the future, if it is not now, that you will have to change. And if you are clear that once you start this process and this is for everymom or dad online, once you start a process, see it through to the end.

Example: Suppose you have been trying really hard for three hours and have been up and down with intermittent periods of rest, and you feel you are getting frustrated, and you go back to the old way. Essentially, all you have done is upset the child for three hours because you did not see it through to the end. Now, you just have a confused child and frustrated parents. So once you commit to doing anything with a child where you are changing a pattern, it's vital you see it through to the end.

Member: Should I do the same for naps?

Hogg: Yes. Your routine should be the same. You build up to the nap and the way you put them down should be the same.

Member: My daughter is now 10 months old. I quit breastfeeding her due to another pregnancy and I know that I shouldn't use feeding to get her to sleep but that was before I read your book. Now she wakes every three hours to be patted or fed. Is it too late to change this behavior?

Hogg: Absolutely not. Once again, you have to be prepared to have a plan. And in order to take away either the food or patting, you have to know that she will display certain behaviors that are not meant to be willful or manipulative -- it's just what a baby will do when you are not doing things the same way. So the plan would be to get rid of the patting by going into her room and tell her it's OK. (I want to stress that I don't believe in the cry-it-out method in any shape or form!) What she will do is fuss and cry because she is waiting for the physical contact. Rather than patting her, lean over the crib and put your lips on her cheek. Pay really close attention to what is a distressed cry in the night rather than her just moving or turning over and crying out. Sometimes we are programmed to jump up and rush in. Stand back and listen. If the cry escalates, go into her immediately.

Don't forget that at this age, separation anxiety plays a big part in her wanting reassurance that you are still there. Providing you go in and make sure she is OK and reassure her of this, then three-hour waking should really phase out.

Member: I have tried to stick it out with the pick-up/put-down routine, but my daughter just doesn't give in. I know it must be my fault for not seeing it through, but really I have tried this all night for quite a few nights. I am just wondering if what people say "to let her cry it out" would be beneficial? Or would it more hinder her than help her? We are talking screaming bloody murder, not just a whimper.

Hogg: I do not advocate crying it out, and it's important for you to realize the trust you have built over the 10 months of this child's life has been established by you always going in and tending to her. The only benefit I could see for you in letting her cry would be that a wooden door would muffle the screaming of bloody murder. Yes, she will cry and be upset, but if you don't see it through to the end, you are prolonging the process. I am speaking from experience of working in homes on a regular basis with children -- babies and toddlers -- who I pick up and put down hundreds of times a night. It's tiring and can put you to the point of exhaustion. My suggestion is that you get support in the middle of the night from a friend or family member. On the Baby Whisperer web site there are even moms willing to do this. Please don't leave your child behind a closed wooden door. I will come out and do it!

Parents should think this through: Our children need to trust our word, and that means following through good or bad so as they grow, when mom or dad makes a promise or gives a refusal of something, those children trust your word. And that's the most fundamental building block in any relationship you have with another human being. It also teaches integrity, respect, and it starts in infancy. And that's why in the toddler book I talk about being a conscious parent. You have to think things through and see them through to the end. And to remember that we are all human, and we all get tired and frustrated -- even I get exhausted. But that's the commitment that we make as parents and it's a very serious commitment.

Member: My 7-month-old takes two good naps during the day. By 6 p.m., he's ready to go down for the night! We slowly get him ready, give him a bath, and he's dropping by 6:45. Then, he's awake by 5 a.m.! That's too early. Any suggestions?

Hogg: I would look at stretching the 5 a.m. rather than keeping him up later. I would look at maybe doing the pick-up/put-down method early in the morning to extend his sleeping hours. I would not suggest keeping him up later.

Member: I asked the question about the 5 a.m. wake up call. I can't do the pick-up/put-down thing when he's got a diaper full of poop. What do I do? Once he's up, he wants to play!

Hogg: If he is regularly opening his bowels at this time, change him. I would not engage in activities until 6 or 6:30 a.m. An idea is to keep the mood quiet and stay in the bedroom with him. It will take two to three weeks for him not to start his day at 5 a.m. He thinks this way now because this is when he starts his day now, at 5 a.m. Take yourself out of the equation and keep things quiet in his room. The only thing we don't have control of is his pooping.

Member: I work third shift and my husband works first shift. When I put my 10-week-old down to sleep on my nights off, she sleeps through the night, but when I am working, she gets up several times for my husband. He gets no sleep. Why does she sleep through the night when I am home but not when I am gone? I put her to bed every single night so she can't know that I am gone. Can she?

Hogg: You would be surprised. She senses it. The level of anxiety from her dad is different from a competent mom and it changes the atmosphere. Ask him if he goes in and checks on her. Children sense when things are different. So there is a big possibility that, yes, she does know when you are gone. But I would be inclined to ask dad if he's anxious and maybe checks on her several times, which could disturb the atmosphere of the room and cause her to wake.

Member: My 4-month-old son will sleep 10-12 hours at night, with no problems. But he has trouble going down for a nap. I know he is tired because he gets so cranky. Any suggestions?

Hogg: Ideally, he should be awake two hours and asleep an hour or hour-and-a-half in the day. And then awake another 2 hours and back up an hour to an hour-and-a-half. To get this rhythm going, you have to initiate it. So to start this way:

Make a note of the time he wakes in the morning.
After an hour-and-a-half to two hours, do the bedtime routine.
In the beginning, don't expect him to go to sleep. Because he has not napped, he won't know what you are doing.
Aim for quiet time.
I would put him in his crib and maybe use the Fisher Price aquarium or give him some toys for in his crib that are not interactive -- maybe Beanie Babies to fondle -- and let him have quiet time in there.
After an hour, get him up even if he has not had a sleep.

And I would suggest that you look at using a clock situation to initiate these naps, rather than his cues. If he is overtired, you will miss essential cues that are telling you that he is tired. For instance, if he's up at 7 a.m., then by 9 or 9:30 a.m. put him back down for a nap. Then the next naptime is about 1 p.m. or 1:30 p.m.

Member: Your approach has been a blessing with my twins. I am 32 weeks pregnant and have 13-month-old twin girls. I've been on partial bed rest at home for the last eight weeks, so I had to bring in help with the girls. One of my twins, the dominant one, is starting to show signs of separation anxiety, crying hysterically when I go upstairs or if she hears me up there. She just wants to be held by me. Reasonably talking to them and explaining to them this is only temporary is not working. Also, now, at night both girls, who used to be great at going to bed, are putting up a terrible fight, crying hysterically. Bedtime has turned into a 30-45 minute fiasco. What can I do to help them get through this, continue to build their confidence and esteem without spoiling them, without jeopardizing my pregnancy?

Hogg: Because the girls sense something is wrong, and you are absolutely right that they are going through separation anxiety, this is really a tough time. The best we can do would be where possible for you to be in attendance at bedtime (not necessarily putting them down) but at least reading them a story.

As for in the day, this is a really fine line to tread because if you don't leave and follow through and say you will come back, she will never get the sensation or the experience of your coming back. With separation anxiety, the return strengthens the security they feel when you leave. It sounds confusing, but again it's about following through and you really do have to nurture yourself with this pregnancy.

Member: I'm a mom who works Monday through Thursday. My caregiver has been letting my 15-month-old sleep until 10 a.m. for the past two days. Usually he is rocket-science sleeper, wakes at 8:30 or 9 am, takes a normal one-to-two-hour nap during the day after lunch, and is ready for bed by 8:30 or 9 p.m. The sleeping in until 10 a.m. makes me believe that he's having trouble going to bed at night and is fighting me/crying when I try to put him to bed at 8:30 or 9 p.m. I've asked the caregiver/mother-in-law to wake him if he's not up by 9 a.m. to try the schedule I use on Friday and the weekends. She advised never to wake a sleeping baby. Is this normal? What else can I try?

Hogg: May I remind you that you are the mother and if you have a caregiver who does not want to adhere to a mother's routine, then darling, you need a new caregiver. And often we feel anxious because we think, "Oh no, I have to go through this process, isn't there an easier way to do it?" From experience, if you are having difficulty with this issue, then down the road you will have more issues with your present caregiver. You will have one heck of a fight later on, which is totally unnecessary. As the saying goes, "It's my way or the highway." Sometimes caregivers think, "Oh who's going to look out after your child if I don't?" It's just not healthy.

Member: How can I help my 16-month-old son sleep and nap away from home? We visit relatives who have a crib, I bring blankets and his stuffed animals, but he still has trouble sleeping.

Hogg: This is really common. Let's take into account not only is he away from home, but he's seeing folks he has not seen in a while. There is extra excitement and attention surrounding him. Keep things as much as possible and practical as you do them at home. However, if you take into consideration what I just said about seeing relatives, be easy on the child if he wants to go to bed later. The main thing is to get back into a routine as soon as you get home. Don't adopt the holiday routine on your return.

For other parents out there, when on holiday, our mood is more relaxed. And the first couple of days I go away, it takes me a while to get into the swing of a new routine even when I'm on holiday. And babies are human beings. So we have to be a little more lenient when we are away from home.

Member: How can you teach a baby to self-soothe?

Hogg: Some babies gravitate to an object, but in my experience it's usually instigated by a parent. So a transitional object is introduced by a parent, such as a blanket or a soft toy. And you have to introduce it when you are doing something that's relaxing, so when you are cuddling them or want to make the transition, give it to them when they are in the crib and introduce it consistently. What a lot of parents do is give them an item and when they don't immediately grasp onto it they give up. Keep repeatedly giving them the object.

Self-soothing comes in many guises. For instance, I have known infants who will throw their legs up in the air and throw them back down on the mattress or rub their head from side to side to soothe themselves. These are the little ones with the bald heads in the back, in the supermarket! Some play with digits -- fingers or thumbs. Some babies pull on their ear. Others make noises. So if you are really observant (all humans have this trait of self-soothing), you should be able to tell what your baby's preference to self-soothing is.

Member: Would there be a reason for an infant to sleep better through the night having had soy-based formula instead of milk-based? Even though she gets milk-based throughout the day and is fine with it? My 4 1/2-month-old daughter has just recently started waking a lot throughout the night. We've just started giving her soy-based formula at bedtime and she has slept better since. Does this make sense?

Hogg: Yes. It certainly can. With milk-based formulas they can get gas. And usually with soy, it doesn't lie as heavy on the tummy. So yes, there could be a connection.

Member: My son doesn't sleep much during the day at 3 months. When can I expect that to change?

Hogg: At 3-months-old they should be taking at least three two-hour naps at two-hour intervals. The other end of the scale is three one-and-a-half hour naps at two-hour intervals. On the whole, they have five hours of sleep in the day and a 10 hour night.

Member: My 5 1/2-month-old daughter has slept through the night since 3 months, but lately has started waking every three hours. What is that about? Is she teething? If so, what can I do so that she goes back to sleep without me having to hold her until she falls asleep?

Hogg: It sounds to me like it could be hunger. This is usually the time you start to see them waking up more in the night to feed, so increase her calories during the day. What tends to happen is that this waking "sticks" and then even though we have introduced more food in the day, we have not gotten rid of the habit of waking up.

Member: What is your opinion of a family bed?

Hogg: If all members of the family are happy with it and have decided that this is what their family will do for the long haul, I have no objection with a family bed. My objection with co-sleeping is when after 8, 10, or 14 months, mom and dad, or one partner, decides they have had enough. And they wonder why the child becomes so distressed. And I am not convinced that when we sleep with our children some element of respect might go through the window, whether it's the respect of the relationship of husband and wife, or it's the respect of intimacy that is shared when there is another human being there (the baby), and there's a lot of objections I have with promotion of independence. But if you've decided to do it, and it's right for your family, then I have no objection.

Member: Tracy, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Hogg: Thank you so much for joining us. All your questions are really important to me. Remember that until the day you draw your last breath you are a parent. It takes patience, commitment, and a box of Kleenex at times to get through the first years of becoming a parent. You will need plenty of support and hopefully I can be one of those support people. Thank you for having me. Come and visit our web site and you can also get questions answered.

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to Tracy Hogg, RNMH, MS, and thank you, members, for joining us today.

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