Frequently Asked Questions

Sleep Setup

Health Screener

Why do I have to wait until my baby is 5 months old to begin sleep training?

Sleep training is recommended for children ages 5 months and older because that’s typically when their motor skills are developed enough to begin self-soothing. Additionally, babies have an easier time falling asleep when they can reposition themselves independently, and those under 5 months old usually sleep in a swaddle and are unable to do this. Babies too young for sleep training can still benefit from an established feeding and sleep routine. Cradle is here to support parents through these first few months with strategies, recommendations, and troubleshooting. Keep tracking and we’ll be there along way!

Why does my baby need to weigh 12lbs to sleep train?

Your baby does not need to weigh 12lbs to be on a sleep plan, but we recommend incorporating a nighttime feeding to support their weight goals. Once your baby weighs in at 12lbs, they will be able to sustain an 11-12 hour sleep stretch at night without needing additional feeds. This also coincides with better eating during the day and increased appetite for meals rather than frequent “snacking” throughout the day and night.

Why is snoring a concern at this age?

Baby snoring is kind of cute but definitely shouldn’t be happening on a regular basis unless your baby is sick. Snoring or breathing through the mouth is a sign that something is obstructing their ability to breathe through the nose. Discuss this with your primary care physician to determine if your baby may have something as simple as allergies or a cold. Depending on the level of snoring, the doctor may recommend a visit to the ENT.

Why is vomiting or back arching a concern?

Babies who have GI or reflux pain often display frequent vomiting, excessive spit-up, and/or back arching. This type of pain makes self-soothing impossible and may require hypoallergenic formula, diet changes, allergy testing, or reflux medication. Please discuss this behavior with your doctor before beginning a sleep program.

What does it mean if my baby’s poop is hard or infrequent?

This can be an indication of constipation which can cause stomach pain and discomfort during pushing. Talk with your doctor about safe remedies for softening the poop and to determine if further medical attention is needed. Visit the diaper section for more information about bowel movements.

What does it mean if my baby has mucus in their diaper/poop?

If your baby has mucus in their diaper or poop, they may be experiencing intestinal irritation during digestion, a potential food or milk protein allergy, or a sinus infection. Please talk with your doctor about the appearance of mucus in the bowel movement and visit the diaper section for other information.

What does it mean if my baby has diarrhea or watery stool?

Babies who are solely breastfed tend to have looser bowel movements and those who are formula fed or eating solids should have soft but formed bowel movements. If your baby is solely breastfed, check with your doctor and lactation consultant to make sure the consistency is appropriate for a breastfed baby. Diarrhea and loose poop usually indicates GI distress and could be interfering with your baby’s ability to sleep well.

What does it mean if my baby has eczema or rashes?

What’s happening internally is often expressed through the skin, so we tend to see allergies or reactions to food through the presence of eczema or rashes. If you live in a dry climate, try introducing a humidifier to their bedroom to provide additional moisture. If the rash or eczema persists, talk to your doctor about treatment and possible causes for the skin irritation. It’s very important that your baby is comfortable during sleep training, so finding out about treatment of a skin irritation should be the first step.

Why are these motor skills important?

These motor skills are what we expect to see for babies who are 5 months or older. If your baby is not yet displaying these skills it would be difficult for them to motor well enough to self-sooth. Sleep training is providing opportunities for your child to learn how to sooth himself but this requires consistent access to motor skills. Talk with your PCP if you feel that your baby is falling behind in motor skills to obtain more information about motor development and strengthening exercises. It’s recommended for safety reasons to keep your child’s crib empty (except for a crib sheet) and have them sleeping on their back until they are meeting their 5 month motor milestones.

Sleep Builder

Picking a bedtime

Depending on your family, picking a bedtime can be earlier or later. There isn’t a right answer. What’s important is establishing a consistent bedtime that allows your baby to stay in bed for at least 11-12 hours. For example, if you want to set a 9pm bedtime, your baby should be able to stay in their bed until 8am or 9am. If your job or other responsibilities require your baby to be awake earlier in the morning (6am) then you’ll need to set the bedtime for 11 hours earlier (7pm). Additionally, naps need to coordinate with morning wake-up and bedtime, so if your baby is still napping twice per day, it’s important that they can take one morning and one afternoon nap before bedtime.

Bed routine

Bed routines don’t need to be elaborate but they should be consistent. The more consistent elements in the routine can be, the easier it is for your baby’s brain to associate them with sleep. It’s also important to keep the lighting in the room low to stimulate the release of melatonin, the natural sleep hormone. Time in a dimly lit room (15-20 minutes before bed or nap) is especially important during summer months when the days are longer and melatonin is released later.

Allowing your baby to cry

This is one of the biggest pieces of sleep training and a natural part of the sleep training experience. One of the most crucial skills for your baby to learn at this age, along with sleeping through the night, is to self-soothe. As children get older, we want their ability to soothe through reasonable stress to increase. Babies can cry for anywhere from 20 minutes to a few hours, so pick a response pattern you’re comfortable sticking with. Your baby will likely cry most the first two nights and then significantly improve on nights 3 and 4. Don’t worry, it will get better!

Response support

These supports are used to replace the sleep associations that your baby has become accustomed to. Your baby will not appreciate the change for the first two nights because they’re unfamiliar and typically aren’t as effective as what they are used to getting (i.e. nursing, rocking, co-sleeping). The important part of these replacement strategies is that they’re forms of support your baby could eventually replicate on their own. These supports allow parents to engage with their babies in a way that does not interfere with the self-soothing learning process.

Support Removal

Support is front loaded in the beginning of the sleep plan to provide extra options for helping your baby learn to self-soothe. After the first few nights it’s important to gradually pull back support to increase the opportunity for your child do calm on their own. The support removal allows parents to decide which support they would like to pull out first, saving the most effective support for last. The goal is for parents to eventually place their drowsy babies in bed and leave the room without the need for any additional support to fall asleep.

Sleep Feed

Sleep feeds are used for babies old enough to sleep train but not quite 12lbs, or for those more than 12lbs who are used to eating in the middle of the night. For babies who are less than 12lbs, it is used to provide additional calories until they hit that weight. For babies who are heavier than 12lbs, it’s used to support their transition to sleeping 11-12 hours during the training process. Ask your pediatrician about appropriateness for your baby before using a sleep feed. Sleep feed is only provided during the nighttime sleep window and can only be offered if the baby is fully asleep. This helps break the association of waking/crying, and getting food in return, which encourages the brain to continue breaking up the sleep pattern. Eventually, the sleep feed is gradually removed until the baby is sleeping through the night without needing an additional feed.

Sleep Routines (For babies 0–5 Months Old)

Baby bedtime should be based on maintaining a sleep routine/response pattern for 8 hours. This means that the longest stretch of sleep should also sync up with closely with parents’ own bedtime.

Most parents feel that an early bedtime is the best choice for this age. However, your baby’s ability to stay asleep for longer stretches is just beginning to develop. This means that your baby will nap more during the day and take an early evening nap (i.e. 6pm) prior to going to sleep for the night. It’s important to separate these sleep events so you can modify your response if necessary. For example, if your baby takes a nap from 6-7pm, engage them in moderately stimulating activities (i.e. tummy time, face time) once they wake up. However, if your baby’s bedtime is set at 9pm and he/she wakes up around 12am, it’s important to keep your baby in his/her room with the lights off or very low and provide a feeding/diaper change before attempting to put him/her back to sleep. A consistent feeding schedule during the day will ultimately promote longer stretches of sleep at night. To help encourage longer sleep, it’s best to approach wake-up during the “bedtime window” (8hrs in length) as a diaper/food check and then right back to bed.

Selecting Bedtime Routines

Establishing bedtime routines and using consistent activities help cue the brain that it’s time to sleep. Recommended bedtime routines include activities that are patterned, repetitive, and rhythmic, such as rocking, singing or listening to music. It also includes types of sensory input that are calming to the system, such as deep pressure (swaddle), gentle massage and nursing. Incorporating these activities into the pre-sleep routine prepares your baby’s brain and nervous system for sleep and makes it easier for them to transition from fully awake to drowsy.

To help your baby develop a sleep-wake schedule it is important to engage him/her in moderate levels of stimulation during the day.

In the first two months it’s possible for babies to develop a problem known as “day-night” confusion where the baby sleeps all day and is awake most of the night. To prevent this from happening, it’s important to keep your baby on a consistent feeding schedule with feeds spaced out according to his/her age. It’s also important to keep your baby in a well lit environment during the day to reduce the production of melatonin, the natural sleep hormone. The lighter environment or being outside helps the brain stay alert and engaged. During these times, parents are encouraged to work on development of skills by offering different opportunities to explore toys, experience tummy time, listen to different sounds and feel different textures.

Wake-Time Activities

Wake-time activities are important because they encourage “alertness” between sleep events. Younger babies should be kept in well-lit areas during these wake-times to reduce melatonin levels and help establish day-night sleep patterns. Tummy time is a great activity for babies to engage in during wake-times because tummy sleep is not recommended for children this age. Providing opportunities for babies to experience tummy time during the day helps to develop motor skills, trunk strength, and arm/hand coordination. Tummy time should always be done with supervision to ensure that baby is not lying with his/her face completely flat to the floor. As your baby gets older, use wake-time activities to help them explore different senses. For example, toys with different sounds, textures, and colors all help stimulate this interest to explore. Bath-time is also often associated with pre-sleep routines, but the feeling of water and water temperature is actually an alerting experience for babies and can help keep them alert during the day. If you feel that your baby is getting sleepy during feed times, rub a damp washcloth against the hands and feet or tickle hands and feet to promote fully awake feedings.

Wake-Time Activities:
Tummy time
Making faces/sounds at baby
Playing with Toys
Bath-time
Tickle hands and feet
Texture Books

Alternative Soothers

One of the biggest obstacles to infant sleep is not having a consistent feeding schedule. This happens for a variety of reasons, the most common being that babies will use nursing and bottle feeds for comfort in addition to intake calories. If your baby is “snacking” throughout the day then he/she is going to wake more often for feeds. This can cause your baby to take in lower volume of milk more often which makes sustaining sleep at night very difficult.
It’s recommended to follow the age-guidelines of how many feeds/day to offer your baby and if your baby is distressed outside of a feeding window to use alternative soothing strategies. Alternative soothing strategies are anything that provides comfort that is not food based. These soothing strategies may be: baby wearing, swaddling, swinging, rocking, offering a pacifier, bouncing on a ball, or “sssshhhing.” As babies get used to these alternative soothers they begin to be more effective at helping your baby regulate. Then when your next feed comes up your baby should be hungry and motivated to take in a full feeding. The more often your baby has a full feed as opposed to a “snack” the longer he/she will be able to sleep.

Sleep Plans (For babies 5–24 Months Old)

My plan involves me being in the room the entire time but now I’m ready to give my baby some time alone, how do I transition out?

Parents have two options here. You can begin by giving your baby a few minutes alone before responding and then step back out every few minutes OR you can gradually stay in the room but farther away from the crib/bed each night until you’re outside the room. The goal is to eventually have your baby feel comfortable falling asleep and returning to sleep without you in the room.

My baby seems more upset by the new supports that I’m using, is this normal?

Absolutely! It’s very normal for your baby to “protest” new changes in your response. It takes a few days for babies to adjust to new patterns, so try to stay consistent and avoid falling back on old supports that keep your baby from practicing their self-soothing skills.

I started with waiting short periods of time before going into the room, now that my baby is getting used to the new pattern can I wait longer?

Definitely! You can always lengthen response wait times if you feel your baby could use a little more time to practice independent soothing. Additionally, if your baby’s cry times are getting significantly shorter it’s better to give them a few more minutes to try to settle before going into the room.

How long do I maintain my response pattern for naps and nighttime sleep?

We recommend using your crying response pattern for 1.5hrs at naptime and 11-12 hours for nighttime sleep. This means if you put your baby down for a nap and he/she cries for ten minutes then falls asleep but wakes crying after only 20 minutes then you will continue using your response pattern until he/she either calms/sleeps or it’s been another hour. If your baby is still crying at the 1.5hr mark then you can take her out and try again at the next nap. However, if your baby falls asleep near the end of the 1.5hr mark then let him/her sleep for another 30-45 minutes before waking him/her up to maintain the schedule. In the same way at nighttime if your baby wakes before he’s/she’s been in bed for 11hrs then use your response pattern until he/she calms/sleeps or if he’s still crying at the 11hr mark then you can take him out. If he/she falls back asleep close to the 11hr mark then let him/her sleep for an additional hour then wake him to maintain his sleep schedule.

What if my baby has pooped during a nap or while sleeping at night?

If you’re completing one of your check-ins and can smell a full diaper go ahead and quickly change the diaper and put your baby immediately back into his/her crib. Most likely your baby will become upset at this transition so return to your response pattern and avoid any extra holding.

What if my baby throws up during a nap or while sleeping at night?

It is not uncommon for babies with full tummies to throw up if/when they start crying. If this happens, immediately take your baby out of his/her crib and change clothes and crib sheet so your baby is comfortable. Avoid any extra holding or soothing outside the crib. It is very important not to reinforce this behavior which will cause it to occur more often. If your baby throws up and you’re concerned he/she is sick, stop sleep training and only resume when you are sure your baby is well.

What if my baby throws the pacifier/lovey out of the crib?

If your baby throws their lovies or pacifiers out of the crib, ignore the behavior until your next scheduled check-in. When the timer goes off you can re-offer these items to your baby, but only them one time per check-in. If you selected a plan without a wait time and are staying in the room until your child is asleep, do not return the lovey or pacifier until your baby is asleep. This way, they are available to your baby if he/she wakes up again later in the night.

What if my baby has a runny nose from crying before bed?

If you notice your baby has an overly wet face during your check-ins, quickly and gently wipe your baby’s face. The goal during this sleep training window is to keep your baby as comfortable as possible while he/she is learning how to self-soothe. If you think your baby is experiencing discomfort (i.e. wet diaper, wet face, wet clothing), always change them quickly to promote comfort but avoid adding extra soothing time. Return to your response pattern as soon as you have made your baby more comfortable.

How do I remove myself from the room once my baby is consistently falling asleep and staying asleep?

The key to removing yourself from you child’s room, if you’ve chosen the option to respond immediately to cries, is to remove yourself gradually. This means that each night you will stand/sit closer to the bedroom door while your child falls asleep. Once you have moved back to the point where you’re sitting outside the door, partially out of view, then you’ll switch your sequence to a “check-in” schedule. This means you will put your child to bed and leave the room; if your child begins to cry, wait a few minutes before entering the room to “check-in” and then leaving to repeat the cycle. The “check-in” schedule allows for parents to give their child a few minutes of crying to promote self-soothing without the parent in the room.

What if my baby has pooped right before bed time?

If you’re completing one of your “check-ins” and can smell a full diaper go ahead and quickly change the diaper and put the baby immediately back into his/her crib. Most likely your baby will become upset at this transition so return to your response pattern and avoid any extra holding.

What if my baby throws up at bed time?

It is not uncommon for babies with full tummies to throw up if/when they start crying. If this happens immediately take your baby out of his/her crib and change clothes and crib sheet so that baby is comfortable. Avoid any extra holding or soothing outside the crib- it is very important not to reinforce this behavior which will cause it to occur more often. If your baby throws up and you’re concerned he/she is sick then stop the sleep training and only resume when you are sure that your baby is well.

What if my baby throws the pacifier/lovey out of the crib?

What if my baby has a runny nose from crying before bed?

If you notice your baby has an overly wet face during your checks then quickly/gently wipe your baby’s face. The goal during this sleep training window is to keep your baby as comfortable as possible while he/she is learning how to self-sooth. If you think that your child is experiencing discomfort (i.e. wet diaper, wet face, wet clothing) then always change them quickly to promote comfort but avoid adding extra soothing time. Return to your response pattern as soon as you have made your baby more comfortable.

How do I remove myself from the room once my baby is consistently falling asleep and staying asleep?

Sleep Feed

What is a sleep feed?

A sleep feed is used for babies who are old enough to sleep train but may not quite be 12lbs or for babies who weigh at least 12lbs but are used to eating during the middle of the night. For babies who are less than 12lbs, it is used to provide additional calories until they hit that weight. For babies who are at least 12lbs, it’s used to support their transition to sleeping 11-12 hours during the sleep training process.

How do I provide a sleep feed?

The sleep feed is only provided 1-2x/night while you baby is fully asleep. It’s important that your baby is cleared by your pediatrician to have a sleep feed and is safely swallowing liquids during the day. Parents can use a bottle or can nurse for the sleep feed but the baby must be asleep (not awake and/or crying) to have this extra feeding. If using a bottle, gently elevate your baby within the crib and place the bottle in his/her mouth (using the same amount given during the day). Your baby will instinctively drink the bottle until they are done or had enough. If breastfeeding, gently lift your baby out of bed (don’t panic if they slightly open their eyes) and offer the breast until your baby is done drinking. After your baby is done drinking, return them to their sleep position in the crib and leave the room.

What if my baby wakes after the feed?

If your baby wakes after the sleep feed, return to your original response pattern and stay consistent until your baby returns to sleep.

What if my baby wakes and is upset during the feed?

If your baby wakes and becomes upset, a sleep feed may be too disruptive. Finish offering the feed and if your baby refuses to eat, place them back in the crib and switch to your typical response pattern. Parents who are nursing can try using a bottle to see if it’s less disruptive, but should remove this additional support if it also seems to be too disruptive. If your baby does not weigh enough to sleep for 11-12 hours without a feed, talk with your pediatrician about postponing sleep training until your baby weighs at least 12lbs.

What if my baby wakes right before I’m planning to do the feed?

If your baby wakes right before you’re set to offer the sleep feed, use your typical response pattern until they have fallen back to sleep. Once your baby is asleep for 15-20 minutes, then you can re-enter the room and provide the sleep feed. The most important rule of a sleep feed is that your baby must be fully asleep.

If my baby makes it 9-10 hours can I give an early morning feed?

Feel free to use more than one sleep feed for babies who are used to eating multiple times per night, but be sure your baby is fully asleep for feedings during the nighttime sleep window (11-12hrs from bedtime). If your baby wakes one hour before their wake-time (i.e. at the 10hr mark) it may be tempting to go in and feed them then to let them sleep for a few more hours but that can reinforce a broken sleep pattern. It’s better to offer an additional sleep feed than to have one “awake feed” during the 11-12 hour sleep window.

How do I remove the sleep feed?

Parents can remove the sleep feed when they’re ready by reducing the amount 1-2oz every other night (for bottle babies) or 1-2 minutes every other night (for breastfed babies) until the feed is eliminated.

Tracking

Diapers & Bowel Movements

What if my baby has a bowel movement while we’re in the process of getting him/her to sleep?

If your baby is still awake and crying when this happens, quickly change their diaper and place them back into the crib. Changing your baby’s diaper will cause an increase in crying but your baby will be more comfortable and likely to fall asleep faster with a dry diaper.

Do I have to change my baby’s diaper if it’s full but he/she is asleep?

If your baby is asleep with a full diaper, we don’t recommend disturbing their rest. It’s likely your baby may have a bowel movement during the first few nights of the sleep training process because he/she will be awake more often during the night. It’s best to prepare for this by using extra diaper cream the first few nights/naps to keep the skin protected.

What should I do if my baby has diarrhea during the sleep training period?

If your baby has diarrhea at any point during sleep training, consult your physician and pause the program until their bowel movements return to normal.

What should I do if my baby becomes constipated during the sleep training process?

If your baby’s stool becomes hard and/or contains mucus or blood, pause your sleep training program and consult your child’s physician before continuing. It’s not uncommon for babies to have periods of constipation when trying new foods, but talking to the pediatrician can also give you ideas of how to soften the stool to make your baby more comfortable.

What if my child takes his/her diaper off while we’re in the middle of getting him/her to sleep?

If your child takes their diaper off and goes to the bathroom in the crib, quickly change the sheets and avoid interaction with your baby. Stay calm and avoid scolding your child, which will make him/her more upset. To prevent this from happening again, use two diapers at bedtime - one positioned normally and the second positioned over the first but placed on backwards to make it harder to remove the tabs. You can also use footie pajamas for the first few nights to make clothing removal more difficult. Older children typically look for ways to change the parent’s response to their crying, so plan for this before beginning to reduce the chance of it happening.

Poop was loose and smelly

Poop never smells great but parents will begin to notice a difference between normal bad poop smells and really bad poop smells. If your child’s poop is consistently loose and/or you’re noticing a change in the smell, they may be eating something that’s upsetting their GI system. Children under three years old are more sensitive to certain food groups. Changes in consistency and smell are usually good indicators of food sensitivities. These changes could also indicate that your baby is sick and has a stomach bug. Poop smells and consistency from a bacterial or viral infection often change and are more noticeable. Your baby would also be displaying more distress during the day from not feeling well. In either case, consult your pediatrician about the best course of action.

Poop was hard and small

This is an indicator of constipation and could make it difficult for your baby to self-soothe. Talk with your pediatrician about safe remedies for softening bowel movements and discuss possible milk sensitivities with your doctor if the problem persists.

Mucus in the poop

Mucus in the poop usually indicates a dairy allergy and can be a sign of intestinal distress. However, if your baby has a sinus infection they could be swallowing some mucus, which is now showing up in the poop. Mucus in the poop during a sinus infection/cold is normal and not a cause for concern but if the cold persists contact your doctor. If your child is not sick, contact your pediatrician to determine if further steps need to be taken.

Diaper Rash

Diaper rashes occur for a variety of reasons: sitting too long in a wet/moist diaper, eating foods that are irritating to the system, teething and yeast. If your baby has recently tried a new food and had a reaction, try eliminating that food to see if it helps clear up the rash. Foods high in acidity (fruits) can create irritation when the poop sits against the skin between diaper changes. If your baby is teething, try to keep them as dry and comfortable as possible, and load up on the diaper cream. If the rash lingers after they are done teething, talk with your doctor about other possible causes. A yeast diaper rash is resistant to normal remedies and would continue to return over-and-over again. Yeast diaper rashes are a deep red, with raised borders, and lesions around the affected area. They usually require a medicated ointment and could be indicative of other GI problems, so contact your pediatrician for assistance if you notice these symptoms.

Poop was an unusual color

White Poop: This poop consistency may appear chalky and is only white in color (this should not be confused with regular brown poop that has white mucus strings in it). Bile, produced by the gallbladder and liver, provide color to poop so the lack of color could indicate a gallbladder or liver problem. Color your doctor immediately.

Pink/Redish Poop: This may initial alarm parents but it’s important to think about foods that your baby has been eating lately. Beets, for example, typically create a pinkish/red tinge to the bowel movements. If your baby’s poop is the consistency of pink gel/mucus then contact your pediatrician immediately because this could be a sign of GI distress/infection.

Red flecked/streaked Poop: Red spots in the poop usually indicate a milk allergy and Mom’s who are breastfeeding should consider removing milk from their diet or switching to a hypoallergenic formula. If the baby is having hard poop with red streaks it’s usually from constipation and the red smears are from rectal tears as the baby is pushing. Bowel movements should be soft (not loose) so talk with your PCP about safe remedies for softening your child’s stool. If your baby has loose stool (diarrhea) and there are red smears in the poop then it can be a sign of intestinal distress and you should contact your pediatrician about this concern.

Mustard yellow (weedy) Poop: This poop color is most commonly associated with breast fed babies and is completely normal. If your baby is not breast fed and/or is on solids then it may be related to what he/she is eating that day. If your baby is not breastfed or on solids and the color is consistently yellow then talk with your pediatrician to determine if there is any cause for concern.

Brown Poop: This poop color is most commonly associated with formula fed babies and is completely normal. Brown is the color we expect to see in diapers so when looking at the poop watch out for consistency. Formula fed babies have more formed stools than breastfed babies (who have watery stools) but if it’s too thick (mud-like consistency) then it’s possible that your baby is experiencing the beginning stages of constipation.

Light Green Poop: This can be an indication of a foremilk/hindmilk imbalance-talk with your lactation consultant for ideas of how to encourage your baby to feed longer to pull the hindmilk. If your baby is formula fed then this color could indicate an virus so talk to your pediatrician.

Dark Bluish-Green Poop: This could be an indication of high iron in the system or a milk protein allergy. If you’re on an iron fortified formula or your doctor has recommended an iron supplement than this can be a common poop color. However, high iron can cause constipation so talk with your pediatrician about ways to soften their stool while on the additional iron.

Black Poop: Newborn babies can have black poop which is normal but if your baby is not a newborn then it may be one of the three: too much iron in your baby’s diet, ingesting blood from Mom’s bleeding nipples, or blood in the digestive tract. The last of those three can be very serious so call your pediatrician right away if you're seeing solid, black stools.

Nursing

Vomited after eating

This could indicate a few different issues: your let-down could be strong, causing your baby to ingest too much milk too fast, your baby could be an “efficient eater” causing them to take in too many ounces too fast, or they could be experiencing reflux as a reaction to milk. If your let-down is strong, try pumping for a few minutes before feeding to reduce the force of your milk flow. If your baby is nice and chubby despite only needing to nurse for a few minutes, they probably have a powerful latch, enabling them to take in a lot of ounces. Either offer a bottle of breast milk to control the amount they take in or pump 1-2 ounces before feeding them to lessen the amount they ingest. If these two causes don’t seem to fit, your baby may be reacting to food in your diet so talk with your pediatrician or lactation consultant about a possible elimination diet. If these solutions don’t bring about a change, talk with your pediatrician. Spitting up is one thing but vomiting is different and indicates significant feeding difficulty.

Nursed for only a few minutes

If your baby is only nursing for a few minutes and struggling to gain weight, they may be having difficulty creating a strong latch. If your baby’s latch is appropriate, check to make sure your milk production is increasing with their growing need. Talk with your pediatrician about checking your baby’s mouth to make sure they are not “tongue tied” which can make it difficult to create a strong latch. Meeting with a lactation consultant can also help you check your milk supply and find strategies for helping your baby latch. If you’re concerned your supply is low, allow your baby to nurse until they are done then offer a 2-3 ounce bottle to see if they continue to eat. If they do, they may not be getting enough from the breast directly.

Shooting pain in the nipple

If your nipples are cracked/bleeding or displaying sharp, shooting pain during and between feedings, talk with your primary care physician about treatment and possible signs of “thrush.” Additionally, if your baby is gassy/colicky and displaying abnormal bowel movements (mucus in the poop) then they may have too much yeast in their system - a symptom of thrush. This can cause problems for both Mom and baby so talk with your PCP right away.

Projectile vomit

If your baby is forcefully vomiting after eating, they may be at risk of having pyloric stenosis. Watch for stomach contractions after eating, which can happen because the stomach muscles are trying to push the food through the narrowed pylorus. Additionally, your baby would be hungry often and display signs of dehydration (low tear production, lethargic). Contact your doctor right away if this seems to be the case.

Fell asleep

Falling asleep on the breast is one of the most comfortable places to sleep, but we encourage using nursing time to eat. If your baby forms multiple associations with nursing, including sleep, they can get in a habit of “snacking” rather than eating efficiently. If your baby consistently falls asleep during feeding, gently try to wake them to stimulate continued eating. Once they are done eating, try to transition them off the breast before falling asleep. If your baby is currently working on their sleep plan try making feed times earlier to prevent them from falling asleep on the breast or gently wake them before transitioning them to the crib.

Woke during sleep feed

The sleep feed is used to help babies who are used to eating during the night adjust to going 11-12 hours before the morning feed. However, a baby that is 12lbs does not need to eat in the middle of the night so if this is not working for your baby it may be best to remove this option from your nighttime supports and just stick to the response pattern for all cries during the nighttime sleep window. If you’d like to keep it, try offering a bottle instead of nursing, which requires less interruption and movement. Bottles for sleep feeds also make it easier to gradually wean down the amount your baby takes in each night.

Bottle

Vomited after eating

If your baby is consistently vomiting following a bottle-feed, they may be sensitive or allergic to the formula you’re using. Talk with your pediatrician about trying a hypoallergenic formula to see if that improves their ability to keep the formula down. It is also possible that the amount of ounces they are eating is too high. Make sure your baby is eating within recommended standards for their age because some babies feed quickly enough to take in 7-8oz but may only have the stomach size to support 5-6oz. Try reducing an ounce from the typical bottle feed to see if that reduces the vomiting. If this behavior persists, talk with your pediatrician right away.

Projectile vomit

Resisted the bottle

If your baby was previously breast fed and is having difficulty adjusting to the bottle, look at a few factors. What type of nipple are you using? Is the nipple size too small? Who is offering the bottle? The nipple size should correlate with your baby’s age but some parents accidentally go for the infant nipple, which makes retrieving the milk very difficult. Additionally, there are wider nipple/bottle sizes that replicate the pressure and feel of the breast that can assist with this transition. Finally, try having someone not associated with breastfeeding introduce the bottle. Your baby may be more willing to take a bottle from someone who isn’t the one usually providing the breast feed. If these options do not improve bottle use, talk with your pediatrician and/or lactation consultant about other options.

Very distracted

As babies get older and notice more of their surroundings, it can be difficult to for them to actively focus on eating. This is actually a good sign because your baby’s visual motor skills are improving, enabling them to take in more of the action in the room. However, this can be frustrating for parents who just want their babies to eat. If your baby is having trouble concentrating on food, try removing them to a calm, dimly lit environment with limited stimulation to help them focus. Make sure their bottle is not timed too closely to when they eat solids (if they are eating solids) because lack of hunger can also decrease motivation to eat.

Fell Asleep

If your baby is routinely falling asleep while eating, try moving the bottle up by 30 minutes to encourage your baby to take in as many ounces as possible before going to bed. If bottle feeding is part of your bedtime routine, keep gently waking your baby to encourage feeding and then remove the bottle and gently wake before transitioning into bed. It’s most important that your baby is semi-awake during the transition so they associate falling asleep in the bed.

Woke during sleep feed

Food & Eating

What if my baby has a reaction to a new food that we’ve tried this week?

During the sleep training period it’s best to avoid integrating new foods as this can cause GI distress and interrupt your baby’s progress towards their sleep goals. If you have given your baby a new food and he/she is having a rash or change in bowel movement, pause the sleep training process and consult your pediatrician before continuing.

What if my baby refuses the bottle before bedtime and I’m afraid he/she will wake up in the middle of the night hungry?

If your baby typically takes a bottle before bedtime but has refused the bottle, talk to your pediatrician about trying a dream feed. Dream feeds are used to give extra calories during a growth spurt or when a baby has not eaten well before bed. Dream feeds should not be used longer than a few nights because it’s important that your baby is eating during the day and not snacking throughout the night. Eating during the night can throw off hunger cues during the day. To give a dream feed prepare a typical sized bottle and after your baby has been asleep for at least an hour, enter the room, elevate your baby and give him/her the bottle. Babies will reflexively drink the bottle and may flutter their eyelids while drinking. Allow your baby to drink as much as he/she wants then remove the bottle and leave the room. It’s important to check with your pediatrician first to make sure your baby is safe to use this strategy.

What are the best foods for my baby to eat before bedtime?

It’s best to use foods that break down slowly and are high in healthy fats (i.e. avocado, almond butter) before bedtime. Only use foods that your baby has already tried and is safely eating.

What if my baby throws up during the sleep training process?

During the first two nights of sleep training it’s best to move the nighttime bottle or breastfeed up by 30-45 minutes to give your baby’s food time to digest. If your baby happens to throw up, immediately respond to make sure your baby’s airway is clear, quickly change their clothes, and put them back into bed. It is very important not to change your pattern in response to vomiting as it can reinforce this behavior and motivate your baby to throw-up during bedtime routines. Babies with a history of reflux are more likely to throw up during sleep training so make sure to reduce food intake before bed to decrease the chance of this happening. After your baby is going down easily at night, add the bottle/breastfeed back into the bed routine.

How can I tell if my baby has had enough breast milk to sleep through the night?

If you’re concerned that your baby is struggling to stay asleep through the night because of hunger, try following each breastfeed with a 2-3 ounce bottle of breastmilk to see if your baby is still hungry. If your baby is consistently drinking the extra bottle, continue to provide it after each feeding and talk to a lactation consultant about your milk supply.

Pushed food out with their tongue

Babies who are 5-6 months old are usually ready to try solids, but some babies still have a sensitive gag reflex and may use their tongues to push food back out. If this is happening, your baby may not be quite ready for solids. Take a break for that week and reintroduce the solids each week until your baby is able to accept the foods with minimal push back. Additionally, if your baby has difficulty sitting up in their high chair their core strength may not be strong enough to support them during feeding. When babies are unable to use their trunk strength to support their upper bodies they instinctively press their tongues to the roof of their mouths for increased head support. This can make it difficult to accept solid foods. Wait until they are sitting with more stability before trying solids again. If your baby continues to struggle with accepting solids talk with your pediatrician.

Had a contact reaction to food

A contact reaction after trying a new food usually indicates that your baby is sensitive to this food and may have a food allergy. Remove this food from your baby’s “try list” and contact your pediatrician about possible allergy testing.

Refused the solid food option

Babies, like adults, have preferences for certain smells and tastes. Your baby may be displaying some aversion to a specific flavor, texture, or smell. If this happens don’t try to force your baby to eat, just take a break for a few weeks and try reintroducing it again later. When parents push a non-preferred food too often the baby can begin to get distressed during feeding times. We want babies to get exposure to new foods to increase their tolerance for a variety of flavors, but we also want food to be an enjoyable experience.

Gagged on the food

If your baby is not just pushing the food out with their tongue but is also displaying a gag reflex or throws up after eating the offered solid food, they may be sensitive to that texture or flavor. Try offering it again to see if this continues to happen (sometimes it just gets caught in a uncomfortable spot while eating) and if it happens again then shelve that food for a few weeks. If your baby continues to gag on certain textures or you notice it happening with a wider variety of foods, consult your pediatrician about feeding support. Occupational therapists and speech therapists often work with young children who have sensitivities to different food textures, smells, and tastes and can provide a wide range of strategies for improving your child’s eating experience.

Sleep

Bumped head in crib

Depending on the age of your baby, they are probably beginning to roll around and move more during their sleep. For the first 5-6 months we recommended not having blankets and padded bumpers in the crib. As your baby begins to move, it may be time to add some cushion to those crib rails. Talk with your pediatrician about readiness and if your baby’s age and motor skills are appropriate think about adding a softer boundary for your baby.

Got leg caught in the crib rail

Depending on the age of your baby, they are probably beginning to roll around and move more during their sleep. For the first 5-6 months it is recommended not to have blankets and padded bumpers in the crib but as your baby begins to move it may be time to add some cushion to those crib rails. Talk with your pediatrician about readiness and if age and motor skills are appropriate think about adding a softer boundary for your baby. If you're concerned about adding padded bumpers consider breathable, mesh bumpers, which don’t provide cushion but prevent limbs from escaping through the bars.

Threw pacifier/blanket/lovey out of the crib

Depending on which response pattern you’re using, only return thrown items during your response window. If you are not providing pacifier/blanket/lovey support at this point in the process it’s recommended to leave thrown items on the floor. Your baby is looking to see what happens when they’re thrown and after 1-2 nights of losing those items they are less likely to toss them out.

My child climbed out of the crib

This can be very dangerous so we recommend lowering or removing the front of the crib to allow your child to safely get in and out. To maintain the response pattern during the sleep-training period you can use a baby gate to contain your child in the room or you can alter your pattern to where you stay in the room to repeatedly place your child back into bed until he/she stays and falls asleep. If you have selected a response pattern where you’re assisting in soothing every few minutes, using a baby gate is an easy way to follow your original plan. The first few nights your baby will probably fall asleep next to the baby gate but will eventually go back to bed without parent assistance. If your child is in a modified crib it’s very important to make sure that the room is completely safe for your child to explore without consistent supervision.

Troubleshooting

Safety

What if my child is climbing out of the crib at night?

What if my child is bumping/banging his/her head on the sides of the crib?

As motor skills continue to improve, it’s very common for babies to move around a lot during sleep. Talk with your pediatrician to see if your baby is old enough to safely sleep with bumpers to prevent this from happening. Until your pediatrician tells you your child is old enough to modify the sleep environment, avoid using pillows, bumpers, and blankets.

What if my child gets sick during the sleep training period of time?

If your child gets sick then pause the sleep training process until your child is completely recovered.

What if my child is standing up in the crib and cannot sit back down?

If your child has not learned how to move from standing to sitting, quickly respond by sitting your child back down and leaving the room. Your child will immediately stand up because it caused a change in your response but if you continue the pattern of sitting him/her down and leaving the room eventually he/she will stay sitting and lay down. You can also avoid responding and allow your child to learn how to sit without assistance. Despite which strategy you chose, it’s important to practice this skill with your baby during the day by having him/her stand at the couch or coffee table and squat/sit to reach toys on the floor.

What if my child’s crying stops abruptly while we’re trying to get her/him to fall asleep?

Cries typically taper off so if your baby/child has suddenly stopped crying immediately go into the room and check on your child. It’s worth the risk of waking them up to make sure they have not lodged a small object in their airway. If you have any concerns about your child’s crying patterns, immediately enter the room to check.

Top Ten Reasons Sleep Training Fails

Inconsistency

This is the most common reason sleep training takes longer or is ultimately unsuccessful. Parents feel that making slight tweaks or adding an additional support won’t affect the larger goal. Unfortunately, the brain needs a consistent pattern to accommodate new information. If you feel that you made some adjustments or weren’t completely comfortable following your plan, return to the settings menu and design a plan that works and will allow you to remain 100% consistent during this time.

Nighttime “awake” feedings

If your baby sleeps for a solid 9-10 hour stretch and wakes up, it can be tempting to use nursing/bottle feeding instead of your sleep training response pattern. Unfortunately, even providing one “awake” feed during the sleep window (11-12hrs) can reinforce the brain’s need to wake the baby up to eat. If you have been sneaking in an extra “awake feed” (not to be confused with a “sleep feed”), return to your designed response pattern for all awakenings and feel free to add in an extra “sleep feed” in the early morning to help lengthen the sleep pattern. Remember, if your baby is awake he/she is working on self-soothing and it’s important to avoid feeding during these times.

Extra Support

Parents pick from the pre-selected “support list” when establishing their sleep plan. This list of “supports” is based on what a baby/child could potentially replicate on their own. We avoid adding in supports that the baby could not replicate (i.e. rocking, holding) which can interfere with the baby learning their own independent soothing strategy. If you’ve added an additional support that requires a parent to complete, it could be preventing your baby from meeting their sleep goal. Start fresh tonight and remind yourself that the supports we recommend using are the best for helping your baby learn how to calm on their own. It may take a few extra nights but your child will get there.

Parent stress

At this stage your baby is very attuned to your moods and overall regulation levels. If a parent is uncomfortable/upset during bedtime routines or sleep responses, it can easily escalate your child’s stress levels. This process is stressful for most parents which is why self-care is very important. Switching out with your co-parent, taking a break from the crying, using deep breathing, can all help with managing your own stress. It’s also important not to start sleep training until you feel ready. If you’ve started and are not quite comfortable, pause your plan for a few nights and begin again when you’re ready. If you’re completing sleep training on your own, think about asking a friend/grandparent for assistance on those first few nights that can be the most difficult. Caring for yourself is one of the best things you can do to help your baby.

Illness

We encourage parents to wait until their child is well/not currently teething to begin sleep training, but unfortunately those things can change rapidly. If your baby became sick during the sleep training window (2 weeks), it will definitely lengthen the amount of time needed to meet the sleep goal. Don’t panic, these things happen, and illness/teething will consistently trigger a regression in sleep. Pause your sleep plan and wait until your baby is well to resume. This may add a few extra nights, but is not the same as starting over again. Your baby is still learning the new pattern so hang in there!

New Motor Skills

Your baby’s motor development is one of the largest areas of rapid development and having improved self-soothing skills can greatly increase the ability to move. Parents may notice their child sitting or standing in the crib, which can be very exciting, but they must be able to get back down! If you’re consistently going into the room to lay your child back down you may notice they pop back up like a jack in the box. Practice helping them go from sitting to lying or standing to sitting during the day. At sleep times either continue providing support to help them transition back down or give them time to figure it out themselves. Fortunately, babies are not very tall so dropping from a standing position to a sitting position only involves a few inches and helps them learn very quickly how to get back down without depending only on help from mom or dad.

Crib Crashers

Younger babies previously content to stay in one position may now begin to actively move around in their sleep. The bumpers that were discouraged for the first part of their lives may now be what’s missing. Children who bonk their heads or get limbs stuck through the crib slats really struggle to put themselves back to sleep. Additionally, if this nighttime movement continues, it may be what’s causing them to consistently wake at night. If you're hearing bumps at night or noticing bruises, talk with your doctor about adding padded bumpers to your baby’s crib.

Altering the Sleep Schedule

The first week of sleep training is difficult because it can take your baby longer to fall asleep, causing you to have to wake them before they’re ready in the morning. Establishing a sleep routine helps your child feel tired at consistent times throughout the day but it takes several days to set up this pattern. Parents may be tempted to let their babies sleep until they wake on their own but because there isn’t a consistent pattern yet babies sleep later, which causes naps to happen later, which dominos into bedtime. Letting your baby’s sleep dictate their sleep/wake times could be delaying how they meet their sleep goals. Babies need to wake within 30 minutes of the 12 hours night window (so they could have up to 12.5hrs) and within 30 minutes of the nap window (allowing 2.5-3hrs/nap). If your baby sleeps 13-14 hours one night, naps will be a mess during the day. Similarly, if your baby takes a 4-hour nap during the day it will make falling asleep at night difficult.

Sleep Environment

For children who are crib sleepers the most important elements to a sleep environment is that it’s cool (67-70 degrees), dark, and quiet (with low-med white noise). However, for toddlers who are using beds, ensuring that toys and other enticing play items are stored is also very important. Some parents may notice that while their child is not coming out of their room they are now playing in the middle of the night which is still interrupting their sleep. Others may feel that their child has an “ace up the sleeve” with getting the parents to alter their response to them by pulling clothes out of drawers or climbing on furniture. Safety is always the most important rule so if your child is climbing on furniture, alter your response to ensure they’re safe. In these situations, look at the environment and temporarily remove the objects that are causing disruptions. After your child begins sleeping through the night, return one object/day until the room is put back together.

Medical Sleep Problem

It’s uncommon, but some babies have a medical piece interfering with their sleep goals. These problems could be anything from a milk protein allergy to low iron to sleep apnea. If you have been consistent with your sleep plan and are not feeling that any of these other “top 10 reasons” fit with your experience, talk with your pediatrician about sleep concerns.

Extending Your Plan

You’ve tried sleep training in the past

Babies whose parents have dabbled in sleep training tend to have a longer “protest phase” and can resist the new pattern because it has changed in the past. For these kiddos it can take a few extra days before the brain responds to the consistent change in response and accepts that pattern.

Your baby wasn’t feeling well

As much as we try to avoid this, some children start teething or get sick right in the middle of the training window and you have to pause your plan. Anytime your child is sick while trying to learn a new skill it’s going to take much longer for it to develop. Stay patient and hang in there!

You modified your approach

Modifying your plan in the early stages of sleep training is a good move for parents who feel the plan they set up isn’t working for their child. However, any change to the behavior pattern where more support was added can lengthen how quickly your child meets their sleep goals. Stick with your current plan and give it a few more days.

You removed your “sleep” feed

Some parents incorporate a sleep feed into their plan to ensure their baby is not hungry during the night. Sleep feeds are a great way to ensure your baby is not crying from hunger. However, it is important to eventually remove sleep feeds so your baby gets used to sleeping 11-12 hour stretches without needing additional calories. When you remove this feed it can trigger a slight regression, which is normal and to be expected. Give your baby a few days to get used to this new change.

You’re not sure but you see progress

If you’re seeing progress but your baby hasn’t reached their sleep goals, give it a few extra days. Some kiddos may just need more time. Based on your baby’s progress, Cradle will prompt you to extend your timeline to help him/her finish the sleep plan. We’re tracking along with you and will offer additional support in a few days if this does not improve. Hang in there!

Attachment and the Brain

Parents in the throws of sleep training have numerous questions for their sleep therapist but none more prevalent than this: “Will sleep training harm my baby’s attachment to me?” This is a valid concern, especially for a parent who has consistently responded to her baby’s cries during the night. To understand how attachment forms and changes with age we have to start at the beginning.

Attachment is founded in being able to consistently respond to your baby’s needs and those needs are determined by what the brain wants. Your baby’s brain begins rapid development within the first seven weeks of your pregnancy! Throughout your pregnancy several neurological structures will be under construction but your baby’s system is throwing a lot of its resources at the brainstem. The brainstem is the first structure to develop and is functional at birth- just in time (!) because now your baby’s brain needs to do what your body was doing for him.

The brainstem is responsible for your baby’s essential physiological functions such as: regulating body temperature, heart rate, breathing, metabolism, and blood pressure. This structure is brand spanking new and even though it’s working the brainstem still needs help learning about its new environment. For this reason it is very important that during the first three months of life that parents are available to help their baby co-regulate. Co-regulation is using your parental intuition to help provide your baby with the comfort he/she needs for the brainstem to “calm down.” When the brainstem is “upset” you’ll notice all of its responsibilities going a little haywire: baby begins to sweat, face gets red, and breathing becomes altered. During this time the brainstem needs help with regulation and needs soothing input that only parents can provide.

After the first three months of life the baby’s motor planning increases with the development of several new neurological structures. These new structures provide your baby with more opportunities for attempting her own self-soothing. During this time your baby is also gaining more weight, staying awake for longer stretches, and exploring his environment by coordinating head and neck movements. Your baby will also begin to bring his hands to his mouth or use them to grab toys. By five months of age your baby is beginning to show independence with moving her entire body and may be displaying soothing preferences. For example, some babies enjoy squealing/babbling to themselves while others enjoy hair twirling or sucking on their fingers. The brainstem is now better able to consistently regulate body temperature, blood pressure, respiration, and heart rate.

This combination of motor skills, weight gain, and improved nervous system regulation means that your baby is ready to learn one of the most important skills yet- self-soothing! Self-soothing requires practice and practice requires opportunities for your baby to experience stress so that she can learn to work through it. Learning to self-sooth during the sleep training process ensures that your baby is in a safe environment, is well fed, and is dry and comfortable. This means that you have met your baby’s needs and are now allowing him to spend the next few nights improving his soothing skills.