Developing a good bedtime routine is one of the first major tasks of parenting. Older children often need a lot more sleep than they think they do and if you allow an active toddler or school age child to dictate their own bedtime they often end up tired and irritable. It is the first time that you may need to impose your will on your child. Newborn babies obviously sleep and feed as they need to and with good management most parents can gently nudge them towards sleeping well at night with regular naps in the day. There is no doubt that babies over six months with good sleeping patterns nap better during the day and are less fretful when awake. Below we suggest ways of gently encouraging your child to sleep at night and also tools for exhausted mothers who have not been able to establish a regular sleeping pattern.

BEDTIME ROUTINE

From about six weeks to three months you can start instituting a bedtime routine – going through the same motions every night helps to calm your baby down and prepare them for going to bed – although it may take a few weeks for it to become fully established.

A commonly used routine follows but is obviously only a guide.

• Supper - starting at four to six months of age (see weaning).   
• Bath (to wash the supper off!)   
• Gentle play – some mothers love their babies to play naked or have a massage at this point   
• Story – babies from the age of six months enjoy lying looking at picture books and hearing very simple stories   
• Milk and burping   
• Bed

Once you are ready to put your child to bed make sure that the curtains are drawn and try and put the baby in his or her cot before they drop off to sleep so they get used to going to sleep on their own – leave on a musical mobile if that helps. Say goodnight and leave them quietly and peacefully. All babies wake up at night and often just settle back to sleep on their own, so if they do wake wait a few seconds to see if they will go back to sleep, and if not check that they don’t need a burp/clean nappy/bit of extra milk before repeating the process of putting them back in their cots.

Always keep the room darkish at night and never start playing or giving meals (solids) during sleep time as this will upset their natural rhythms.

Your aim is to reassure the baby that the cot is a safe place to be, so be aware that rushing in and picking them up the second that they murmur in their sleep or are slightly awake or a bit grizzly may reinforce the message that they are right to be afraid of the cot. Often just going to them and stroking them in the cot – reassurance that everything is OK - will be enough to help them get back to sleep.

If you do get in the habit of getting your baby to sleep in your arms it is often very hard to put them in the cot without waking them up.

A large part of the knack of establishing good sleep patterns is feeling confidence in yourself as a parent and knowing when your baby is really distressed or just restless.

Some parents leave a background noise on (womb sounds are popular) and most experienced parents agree that it is best not to creep around when the baby is asleep as the normal hum of domestic activity will be calming to them during their periods of wakefulness.

During daytime naps leave the curtainsso the baby develops a normal circadian rhythm and has longer sleeps at night.

Dummies – a lot of parents like dummies but they may cause some problems – often babies who go to sleep with dummies in their mouths wake up when they fall out as the babies’ mouths usually relax as they go to sleep. Although your baby may go to sleep faster with a dummy they may also wake up several times and need you to go and replace it. They have also been linked to an increased risk of cot death – all dummies sold now should have adequate ventilation holes but check your baby can breathe properly particularly if they have a cold, or narrow nasal passages.

Night feeds – for the first few months your baby will need feeds of milk at night – always keep these feeds as quiet and calm as possible after the baby is a couple of months old– don’t put on bright lights or music or televisions but try to maintain the calmness of night time. Don’t feed your baby lying flat on his or her back as this can increase the risk of glue ear. If your baby is over six months, gaining weight well, on solids during the day and bottle fed you can try slowly diluting the night feed to get them out of the habit of wanting calories at night – but ask your midwife first.

Obviously babies who are premature or have medical problems may not settle into a routine quickly and easily. Some babies are very difficult to settle so if you aren’t able to get your baby to sleep for longer periods at night do ask your doctor or midwife for advice – prolonged periods of sleeplessness can have a profound effect on your ability to cope and can sometimes lead to depression or negative feelings about the baby so do ask for help if you feel that things are getting on top of you. You also need to check that there aren’t any other problems such as earache or reflux causing the sleeplessness.

CONTROLLED CRYING

This can be a very useful tool for the parent of an older baby who does not sleep well at night and needs constant attention. It can also help babies who cannot get to sleep on their own. In babies and toddlers older than 9 to 12 months it often gets them sleeping through the night within a few nights. It is well described in ‘Toddler Taming’ by Dr. Christopher Green.

First of all seek medical advice that your baby is well and gaining weight and growing properly – make sure that you have followed the advice above about keeping the room darker during night time hours and cutting out night feeds. Both parents need to be committed to getting their baby or toddler to sleep. If you let your child cry and then give in and take him or her out of the cot or bedroom you are just reinforcing that they are correct to be afraid of their cot and that they will be taken out of bed eventually.

Put the child into the cot or bed and explain that it is bedtime now and that you are going to leave them to sleep. If your baby or toddler cries, go back after a set amount of time – say one minute – pat them and reassure them that you are there, then repeat that you are going to leave them to sleep and leave the room. Leave that child again for a set amount of time – one to five minutes depending on the age of the child and then repeat – you are not abandoning your child or leaving them to ‘cry out’ but constantly reassuring them by your repeated presence and attendance that you are there if they need you but that if they are otherwise alright you want them to sleep now. This process may take a few hours on the first night but usually within four nights they will go to sleep alone and sleep through the night. A typical pattern could be four hours crying on the first night, two on the second, then twenty minutes down to a couple of minutes on the fourth night.

Most parents will need some support to plan this so arrange to talk to your doctor and call your midwife daily to talk through how you are getting on – also warn the neighbours. Mostly parents who need to use this technique are so exhausted and befuddled with lack of sleep that they cannot seem to correct things with more gentle methods – but with good supervision it can work dramatically and effectively. Remember if you do feel exhausted and unable to cope with your crying baby or sleepless child do ask for help – most parents go through this but very few admit to these feelings of desperation publicly – it is sadly seen as a sign of weakness in a world where everyone is trying to appear to be a supermum.

TODDLERS

Toddlers who get out of bed should be put straight back in. Avoid eye contact or prolonged chat and don’t give in to demands for attention that are unreasonable. ‘But I said I wanted the blue cup’ etc are common wiles of sleepless toddlers – draw up a game plan in advance of what is and isn’t allowed, discuss it with your child and stick to it. Agree in advance about night-lights, drinks, number of bedtime stories etc. You may need to sit outside their bedroom door for quite a while at first just putting them back to bed as soon as they get up – enlist a friend to give you moral support - but they’ll soon get the message. I have heard of parents securing the child’s bedroom door or even parents locking themselves into their own bedroom so that they could get some sleep!!

OLDER CHILDREN

Again a good bedtime routine is important with ‘winding down’ time before going to bed– avoid television, computers and electronic games in the hour or two before bedtime. Resting in bed is almost as good as sleeping – so reassure your child if they are worried about not getting to sleep. Reading helps them to relax in bed before going to sleep. Finally don’t forget that suddenly not sleeping can be a sign of anxiety and may indicate other problems such as bullying at school or academic anxiety.

Also see insomnia in our health section.

CO-SLEEPING

Some people find co-sleeping (sharing your bed with your baby) is a solution. But please note that babies can easily be smothered by pillows and bedding – see our cot death guidelines - so always be vigilant if you feed a small baby in your own bed at night especially if you are tired, on medication or have drunk alcohol as it is easy to inadvertently drop off.

FURTHER READING

We have been sent a couple of links by a reader - 8 INFANT SLEEP FACTS EVERY PARENT SHOULD KNOW discusses the changes in blood flow to the brain and REM sleep patterns in infants and revives the old saying that infants who don’t sleep well are cleverer – not proven but maybe of some comfort to exhausted parents.

Some parents have contacted us about co-sleeping – I have no experience of it professionally but if you are interested a book has been published detailing one mother’s personal feelings about sleeping with her family – you can read about it at Mothering Magazine -- Three in a Bed.