Q&A: Sleep and settling techniques

Mater midwives Judy Cunningham and Jane Swan today chatted with mums online about sleep and settling techniques. Our experts answered questions ranging from what is the best position for babies to sleep in and what kinds of things should be put in and kept out of bub’s cot. 

For those who missed today's chat, we have saved the questions and answers for you below.

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Questions and Answers

Q: What’s the best position for my baby to sleep in?

A: The safe sleeping recommendations, including from SIDS and kids, are that you should always sleep baby on their back (not side or front). Wedges and pillows or rolled towels should not be used, and the cot or bassinet should be in a flat position. Our motto is 'back to sleep, tummy to play'. Regular tummy time when your baby is awake, will help your baby develop the muscle strength necessary to learn to roll, sit and crawl.

Q: How do I help my baby learn the difference between day and night sleeping patterns?

A: It’s very normal for babies to wake and feed during the night as it can take a couple of months for their circadian rhythm to kick in. If your baby is feeding frequently all night and then having lovely long day sleeps, the best way to change this around is to offer more regular day feeds every 3 hours or so. Increase the frequency of feeds in the evening to imitate a cluster feeding pattern until the time you wish to go to bed, and then demand feed overnight. This will give you the best chance for your baby to sleep longer at night. And like us, avoid stimulation and bright lights before bedtime and throughout the night.

Q: I heard my baby’s feet should be at the end of the cot. Is this correct?

A: Babies should be positioned so their feet touch the end of the cot. This helps prevent them from sliding under the bedding and prevents their face and head being covered (another safe sleeping recommendation). Sleeping bags are a great option as they can be purchased in winter or summer weights and negate the need for bedding. If using a sleeping bag, your baby can be placed in any area of the cot.

Q: My 18 month old toddler used to sleep through the night but for the past 6 months he's been getting up 2-3 times every night.  He goes to bed at 7.30pm and will sleep through until midnight, but after that seems to have broken sleep.  How can I get him to sleep through the night? I usually tap him or rock him back to sleep, but he also seems to comfort feed at least once every night. 

A: It sounds like you've got a good bedtime routine happening to get him to sleep. Resettling during the night can be difficult; it could be worth trying to work out why he's waking up - is he hot or cold, does he need a nappy change or feed or is he just looking for reassurance that you're nearby? When you go in to settle him, try not to overstimulate him with too much tapping or patting, more just quiet comfort until he is quiet. Once that happens, you may be able to leave the room, even if he's still awake. See if you can get by without giving him a feed as that may become routine and he will keep waking for it.

Q: My husband is quite naughty because when it's his turn to settle him down at night, baby usually ends up in our bed!  I try to keep him in the cot so we are all comfortable. Is this okay? 

A: Like many other families, toddlers may spend part of the night sharing a bed with the parents! 

Q: I have a 4.5 month old boy.  I tried about 1.5 months ago to start teaching him to self-settle and it was a disaster.  We didn't realise at the time but he had reflux and I think this was contributing to his difficulties.  His reflux is now under control with medication.  We would like to be able to put him to sleep without having to rock him. Would you wait a bit longer before having another go at self-settling?

A: You're right, having reflux would have interfered with his ability to self-settle. You could probably have another go at self-settling now that he's 4.5 months old and that the reflux is under control. Babies have certain ‘signs’ they exhibit to let us know when they are tired. Yawning, facial grimacing, jerky limb movements, ear pulling or face rubbing and whinging or crying are some of the most common signs. Try settling your baby when they begin demonstrating these tired signs as they will likely settle more quickly and efficiently. An ‘overtired’ baby usually takes longer to settle.

Q: My 6 month old used to sleep from 9pm to 6am, but for the last 8 weeks tends to wake every two hours or sometimes every hour. How can I get him to sleep through? I have been feeding at every wake, but I’m wondering if this is a good idea or setting a bad pattern. I try settling via patting him back to sleep, but this only tends to work for a very short time, but if I pick up and rock him back to sleep he will sleep longer. Should I persist with not picking him up? He has solids 3 times a day and milk 5 times a day and has become less interested in his dinner. 

A: Sometimes at this age, babies can get distracted by everything going on around them and as a result, don't feed as frequently during the day. This leads to more night feeds. Try feeding in a quiet place during the day and perhaps not to feed as frequently at night time; that can drive better feeding during the day. With regards to picking him up - it is better to settle him to sleep in the cot rather than on you because the move from your arms back into the cot can wake him.

It sounds like he's still feeding well during the day, so it could just be a settling issue and probably doesn't need to feed frequently overnight for nutrition - it's more likely a comfort thing. Perhaps try other ways of settling him instead of giving him a feed. You could pick him up and cuddle him, but put him back in the cot before he falls asleep. Although it would be better if you could settle him in his cot rather than picking him up.

Q: I thought my baby was waking and feeding just for comfort overnight due to his first teeth just about to cut. I have tried just comforting without picking up, he drifts off but only tends to last an hour.

A: Teething can definitely make babies unsettled. They usually return to a better sleeping routine once their teeth have cut through the gums. If you start feeding frequently during the night, he may then start waking because of that routine, even after his teeth have come through. So try to use techniques other than feeding. You're doing a great job and hopefully things will soon return to normal once those teeth pop through!

Q: When checking on my baby through the night his arms are very cold (he sleeps in a sleep bag with a short sleeve top on, so everything else is covered) and his legs are cool when I do a nappy change. Hubby worries about overheating. What should I be sleeping him dressed in?

A: The most important part is keeping your baby's core or trunk (chest area) warm. But if his arms and legs are cold when you change his nappy or pick him up, you may want to try a long-sleeved shirt. Their hands and feet can be cold, but if their arms and legs are, they may need something slightly warmer.

Q: What kinds of things should I put in my bub’s cot? There are so many things in the shops!

A: First of all, a safe sleeping environment consists of a cot that meets Australian standards with a firm, well-fitting mattress. To ensure good air flow and prevent baby from overheating, we recommend you remove all pillows, doonas, loose bedding, lambs wool (sheepskin), bumpers and soft toys from the cot. To keep baby warm, they can be covered with a blanket from chest down, ensuring their head is free. This blanket should be tucked in firmly and baby's feet should touch the bottom of the cot so they can't slide around. Alternatively, you can put baby in a sleeping bag, which are available for different climates. This means you don't need to use a blanket.

Q: No bumpers? They are in all the shops!

A: Bumpers restrict airflow and babies can get their little heads stuck between them or have their face squished into them.

Q: My baby is three months old, how much sleep should she be getting each day?

A: Sleep patterns vary baby to baby, but by the three month mark, babies are often more alert during the day and may sleep a little less between feeds but may have longer periods of sleep at night. They will still wake for feeds at night but they'll often then go back to sleep.

Q: Is there an ideal temperature for sleeping or can we have the air conditioning on?

A: If you want to have the air-con on, it's okay, but be mindful of the temperatures as you may need to dress your baby warmer for sleeping. Overheating is one of the risk factors for SIDS so also think about what you're wearing or sleeping with - a baby can't kick off their covers the way we can.

Q: Sometimes my 4.5 month old falls asleep when I feed him. Is this a bad habit? He usually rouses a bit when I then put him in his cot but can usually go back to sleep. I was worried I might be creating bad sleep associations?

A: It sounds great to us! That's what babies do. He's obviously very happy and content at the end of his feed.

Q: My baby is 10 months old and sleeps pretty well in general. She is usually in bed by 7 pm and will sleep through mostly until 5 am although will sometime wake about 4 am. I have been giving her a bottle and she will go back to sleep but I'm wondering if I should be trying to resettle her without a bottle? I've always assumed that by then she has a good amount of sleep and is hungry. 

A: It might be worth trying to re-settle her without a bottle as she may go back to sleep again. If you keep feeding her at this time, it might turn into a habit and she'll keep waking for it. If you're happy to start your day at that time, you can do the early feed, but she may be okay to last 12 hours.