Q. My seven-month-old son has started to wake a few times a night and I am exhausted. He used to be a relatively good sleeper and for about a month he slept through the night. Then he got sick and we were comforting him at night; now he continues to wake. The only thing that helps him get back to sleep is my feeding him. I know this is a bad habit but it is the only thing that seems to comfort him. I certainly don’t want to leave him upset and don’t feel comfortable letting him cry himself to sleep.

I have breastfed him since he was born but in recent weeks I have been weaning him off and introducing a bottle as I am due to go back to work in three months. I also have a two-year-old daughter who is a handful and demands my attention during the day. My husband is a great help when he is there, but unfortunately he has to work long hours. My sister lives nearby and she will mind the children when I go back to work. Have you any suggestions for getting my son back into a good sleeping habit?

A. Establishing good sleeping patterns in young children is all about good routines and habits. As you have discovered, good routines can easily be disrupted by sickness, development changes or by children becoming overtired during the day. I share your concern about using “cry it out” methods with young children, but the good news is that there are lots of gentle “no-cry” solutions that can gradually help re-establish sleep patterns. With patience and time you can help your son relearn how to self-soothe and get back to sleep by himself.

Breaking the link between feeding and sleeping
During a night’s sleep, children tend to go in and out of deep sleep and normally wake briefly a few times before falling back to sleep. Some young children seek their parents to comfort them when they wake and some become dependent on their parents to support them getting back to sleep. In your situation, your son associates the comfort of being fed with going back to sleep and has become dependent on being breastfed to get back to sleep. Your goal is to try to help him gradually learn new sleep associations and new rituals that help him get back to sleep.

Establishing a relaxing bedtime routine
The best place to start this is during his bedtime routine and not in the middle of the night. At this time you want to make sure to feed your son earlier in the bedtime routine and not at the point of sleep.Make sure he is well fed before he goes to his bedroom and then go through a series of relaxing bedtime steps in his bedroom such as putting on pyjamas, reading a story, listening to music and so on.

Make sure the last few steps take place in his cot where he will fall asleep, surrounded by lots of positive sleep associations such as a teddy bear or a comfy blanket . If he does seek to be comforted by you, try to comfort him while he is in the cot and lying down. To help him learn to self-soothe, the key is to stop comforting him when he is relaxed but before he falls asleep, so he takes the final step of getting to sleep by himself.

Increasing the quality of daytime naps
Children who have good naps and are well rested during the day tend to sleep better at night. To improve your son’s night-time sleeping, you can try to improve the quality and length of his naps. Ideally these naps should occur earlier in the day and follow a similar routine to bedtime, ie take place in his cot and follow the same bedtime steps that encourage him to self-soothe and fall asleep by himself. The key is to always put a child down for a nap when he is sleepy but before he is overtired.

Dealing with night waking
When dealing with your son’s night-time waking, the key is to help him get back to sleep with as little support from you as possible and in a manner that is least disruptive to you both. This might mean first waiting to see if he settles himself after the first few cries, or then going in and simply patting him quietly without picking him up. Some parents are happy to take the child into their own bed during the night to comfort them as this is least disruptive to them. Some parents consider the alternative of lying beside their baby in his room for a few minutes, which has the advantage of him learning to go back to sleep in his own cot.

Once you have a pattern of settling him at night, you can choose to reduce your support gradually over subsequent nights – just pat him rather than pick him up or try to support him falling asleep in his cot rather than taking him into your bed, and so on – as he learns to sleep by himself.

Getting support
Finally, dealing with sleepless nights is stressful and it is really important that you look after yourselves as parents. As you are weaning your son off the breast, this is a good time to allow your husband to share the role of giving your son his last feed, putting him to sleep and dealing with the night waking.

Many couples I have worked with take turns for the night duty so they at least get an alternate decent night’s sleep, which makes the process more manageable. It also provides a great opportunity for Dad to get more closely involved with his son.

Dr. John Sharry, The Irish Times, October 2014. John writes in the Irish Times Health+ every Tuesday.

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