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Editorials for Clinical Practice

CHADIS Co-Director and President, Dr. Barbara Howard is a regular contributor to the Behavioral Consult column of Pediatric News and an Assistant Professor of Pediatrics at The Johns Hopkins University School of Medicine.


Dr. Howard is a developmental-behavioral pediatrician trained by Dr. T. Berry Brazelton at Harvard University. She is a national speaker on child behavior problems and is a past president of the Society for Developmental and Behavioral Pediatrics. She was a contributing author for Bright Futures™, Diagnostic and Statistical Manual for Primary Care (DSM-PC) and Bright Futures in Practice: Mental Health and has served on national committees of the American Academy of Pediatrics.

If babies don't sleep at night, check feeding schedule

Barbara Howard, MD

PORTLAND, ORE. – Sometimes, parents who get great advice in the hospital about how often to feed their newborns are in the pediatrician’s office a few months later because their baby isn’t sleeping more than a couple hours at a time, and they don’t know what to do about it.


They might have a "trained night-feeder" on their hands, according to Dr. Barbara Howard of the department of pediatrics at Johns Hopkins University in Baltimore.


In the nursery, parents are often told to feed on demand, but "we don’t remember to tell them to change that" after the first several weeks of life, so the child keeps to the schedule. At 4 months, he might still be waking up every 90 minutes to be fed, she said.


It’s not necessary. Half of kids at a month and a half and 95% by 4 months of gestational term age, can go 8 hours without feeding, Dr. Howard said at a conference sponsored by the North Pacific Pediatric Society.


The trick to breaking the pattern is to lengthen the daytime feeding interval. "Make [the baby] wait just a little bit longer when he starts fussing, until you’re aiming for about 4 hours between feedings. Make sure he is getting a feeding before the parents go to bed," as well. Don’t go cold turkey, either, if the child is used to an 8-ounce feeding at 2 a.m.; it’s kinder to slowly decrease the amount over a week or so, Dr. Howard said.


The fix is a bit more complex if the child is used to falling asleep with the bottle or breast in her mouth; she might need those familiar comforts to fall asleep after awakening for her 2 a.m. feeding.


To prevent the association – or hopefully break it if it’s already established – "advise parents to put the baby in bed at least a little bit awake, starting at about 2 months of age. Let her fuss just a little bit, make sure she opens her eyes," she said.


"Does that mean [mothers] can’t breastfeed the baby until she is asleep? Well, it’s okay to do that, but they need to wake her back up to put her in bed," she said.


A lot of mothers and fathers might also want to share their bed with their child for the first few months, which also isn’t necessarily a bad thing.


In many places, "it’s become our policy [that] we say ‘No, you shouldn’t sleep with your baby,’ [but] really, it’s often about parents" wanting to give their child a "cozy first few months of life, and I don’t think that’s a terrible thing," Dr. Howard said.


Plus, parents are going to do it anyway, "so I think it’s better to be on the up and up with [them] and say ‘here are some things you need to be careful about,’ " she said.


Entrapment in soft bedding is a real danger, as is "a parent who sleeps too deeply. Usually they are obese, or using substances or alcohol, and they overlie their child," she said.


Eight months is about the limit for co-sleeping. Developmental night waking starts about then and will make breaking the habit "more of a struggle," she said. 


Dr. Howard’s contribution to this publication is as a paid expert to Frontline Medical Communications. E-mail her at


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