When your baby won’t sleep: reasons & what helps

Newborns wake again and again to feed for the first few months. As babies grow, they need fewer night feeds. Between 6 and 12 months some no longer need night feeds, but hunger may still wake them.

Being too hot or too cold can disturb a baby’s sleep. Overheating also raises SIDS risk, so dress your baby in about one layer more than you’d wear.

The AAP suggests keeping a diary of your baby’s sleeping, eating and crying patterns. It helps you spot triggers and gives your baby’s doctor useful information.

Zero to Three lists sleepy cues such as yawning, pulling at ears, rubbing eyes and fussiness. Starting the wind-down when you see them can help.

The NHS notes that overstimulation before bed can cause waking, and suggests keeping the bedtime routine calm and consistent.

Too much activity or stimulation is also one of the common reasons for fussiness the AAP lists.

Keep days active and nights calm and quiet. Speak softly and keep things low-key during night feeds and diaper changes.

Some babies show separation anxiety at 4 to 5 months, and most show stronger signs around 9 months, once they understand that people still exist when out of sight. Some children first show it at 15 or 18 months.

Zero to Three suggests doing the bedtime routine in your baby’s room, then leaving and checking in briefly every few minutes, without turning on lights or picking them up.

New skills are on Zero to Three’s list of things that can disrupt sleep. Lots of daytime practice can help your baby feel confident with a new move.

Practicing with a portable crib at home, bringing familiar sheets and a comfort routine, and offering brief check-ins can help when traveling. Sleep usually settles within a few days of getting home.

New childcare or caregivers can also bring more night waking. A steady bedtime routine and short, calm reassurance help.

Most sleep disruptions ease as a child gets used to a change. Getting back to regular sleep habits quickly after a disruption helps.

Ideas from the AAP

• A clean, damp washcloth chilled in the freezer (not frozen solid)
• A soothing bath or bedtime massage
• Gently rubbing the gums with a clean finger
• Soft rubber teething toys
• Low white noise at bedtime

The AAP advises against teething necklaces (amber, wood, marble or silicone), liquid-filled teething toys, and numbing or homeopathic teething gels. If your baby seems very uncomfortable, talk to your baby’s doctor about pain relief.

Teething does not cause fever, diarrhea, diaper rash or unusual crying. If you see these, call your baby’s doctor, because something else may be going on.

The AAP says to call if

• Your baby is under 3 months with a temperature of 100.4°F (38°C) or higher
• A child of any age has a temperature that repeatedly goes above 104°F (40°C)
• A child under 2 has had a fever for more than 24 hours
• They still seem sick after the fever comes down, or seem to be getting worse

The AAP advises calling the doctor if your baby is fussy after feeding, spits up or vomits a lot, or is losing weight or not gaining. Your baby’s doctor can check for reflux or other causes.

Call right away if your baby has trouble breathing, looks very ill, is unusually sleepy or very irritable, has a stiff neck, an unexplained rash, or repeated vomiting or diarrhea.

Babies can’t keep a consistent schedule before about 4 to 6 months. Until then, follow your baby’s cues for feeds and naps. A repeated lullaby before naps can lay the groundwork for a routine later.

For babies 4 months and older, the AAP suggests putting them down drowsy instead of waiting until they are fully asleep, so they learn to fall asleep on their own.

The AAP notes babies need a little time to settle themselves, and suggests not always rushing in at the first sound. Still respond when needed, for a feed, a dirty diaper or illness.

Responding to your baby by feeding, rocking or cuddling to sleep is a loving choice, especially in the early months when babies follow their own cues.

If it’s working for your family, there is no need to change. If you are exhausted or your baby wakes often looking for the same help, you might try one of the gradual options.

You temporarily move bedtime later, to when your baby usually drifts off, so they fall asleep quickly. Then you bring it earlier bit by bit. In a small trial, this helped babies fall asleep faster.

You sit beside the crib while your baby falls asleep, then move your chair a little closer to the door every few nights. It was one of the two options families could choose in a large Australian trial.

You leave the room and come back for short, calm check-ins, waiting a little longer each time before going in. In trials, this reduced night waking and helped babies fall asleep faster.

Questions to ask yourselves

• How much crying can we each cope with?
• Is our baby well, feeding well and old enough?
• What fits our values and home?
• When can we start: a calm week, not just before travel or a big change?
• Who will do which nights?

In an Australian trial with 156 mothers of babies aged 6 to 12 months, 70% of babies in the sleep-support group no longer had a sleep problem after 2 months, compared with 47% in the information-only group. Mothers with higher depression scores improved more, and that lasted at least 4 months.

A follow-up of 225 families found no long-term differences in children’s emotions, behavior, sleep or closeness with their parents at age 6, between families who used check-ins or camping out and those who didn’t. There were no lasting benefits either.

In a trial of 43 babies aged 6 to 16 months, check-ins and bedtime fading both improved sleep. Babies’ stress hormone levels did not rise, and 12 months later there were no differences in bonding or behavior.

Many trials were small, and most included healthy, typically developing babies over 6 months. Choosing not to sleep train is also a valid, safe choice.

Passing your sleep routine on to grandparents, sitters and childcare helps your baby feel secure when someone else puts them down.

Some babies settle more easily with the parent who doesn’t feed them. Others want one parent only. Agree who leads at bedtime and how the other can help, like doing the bath or covering the morning.

Night-time is the worst time to debate a sleep plan. Pick a calm moment, share what each of you can cope with, and agree on a trial of a week or two before reviewing.

If you feel angry or overwhelmed, put your baby on their back in the crib, leave the room to calm down, and check on them every 5 to 10 minutes. Ask a friend, relative, neighbor, helpline or doctor for help.

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