Q&A: early morning waking with 15-month-old

Amy writes:

"Okay...so we have tried everything to get 15-month-old Edie back to sleep in the middle of the night and to get her to sleep later in the morning. Here's the run-down: she sleeps only until 4:30-5 AM and wakes up in the night, often to stay awake for extended stretches. We have tried everything: rocking, co-sleeping (she won't sleep in our bed-- just thinks it's a chance for play), medicine when it seems needed (Orajel, Motrin, etc.), massage, sleeping by her crib, sitting by her crib patting her back, earlier bedtime, later bedtime, changed naptimes, different foods, etc. Absolutely nothing works. When she wakes up in the middle of the night, she will just sit there, eyes wide open, and then the second I leave or my husband leaves her room, she's screaming. And this can go on for hours; sometimes she's awake for 3-4 hours at a time in the middle of the night.

So at what point do you just go with cry it out? Last night we did that. She cried off and on (more off than on, but with regular crying jags) from 2 AM to 5:30 AM. She's one of those high-needs babies who still has to be rocked to sleep. Will this change if she's able to get herself to sleep without rocking? Will it change if I stop giving her a bottle before bed? Will it just change when she grows out of whatever phase she's in or gets whatever teeth she's getting...? I know there isn't a hard-and-fast answer to any of these questions, but I'm interested in ANY AND ALL input."

This is just so frustrating. 15 months is usually when kids really start to sleep all the way through if they haven't been before, even if it's not every single night.

The first thing that hit me is that this may be some strange kind of night terror. What makes me think that is that she wakes up and stares and then is inconsolable. (Here's my post that discusses night terrors. Scroll down to the comments--I didn't have the answer--to see the only solution that seems to consistently work, which is waking the child up 15-20 minutes before the night terrors usually happen--and then letting her go back to sleep--so the cycle is interrupted.)

So the first thing I'd do is see if the solution to night terrors helps you daughter. If it does, then it was pretty simple. The second thing I'd do is offer a snack. She's probably really mobile at this age, and she might just be really hungry in the middle of the night.

If neither of those help, then you're going to have to do a little more work (although not necessarily more than you're doing now). It sounds like even going in to comfort her doesn't actually comfort her or get her back to sleep, so it's not a choice of comfort her to sleep vs. cry it out. It's more like "what is possibly going to get my kid to sleep???".

As much as the CIO people* want us to think that every baby will cry to sleep, there's plenty of testimony to the contrary. Some kids just get more and more upset the longer they cry. So before you do CIO, you really have to figure out how it's going to affect your kid. If your kid releases tension by crying, then it's probably going to work to help the kid settle down**. If, however, you have have a kid who gains tension or anxiety by crying, then doing CIO is just shooting yourself in the foot, because crying is going to make it worse.

The upshot of all that is that you have to observe your own baby (and every subsequent baby, because kids can be radically different from their siblings) to see how crying affects them. That's the only way to know if you're being "forced" to do CIO. (I really don't think anyone's ever "forced" to do it. If your kid releases tension by crying, then you're helping them fall asleep by letting them release that tension, and you aren't being "forced." If your kid gets worse by crying, then you shouldn't let yourself be forced or talked into CIO because it's going to make everything worse. But my basic philosophy about parenting is you have to make your decision and then make peace with it, so I think feeling "forced" into doing something is counterproductive anyway, unless it's something you really were forced by someone else into doing.)

But back to Amy's specific problem. If I were in that situation, I'd spend a lot of time during the daytime talking about how nighttime is for sleeping, and Edie is a big girl and can go back to sleep when she wakes up. I might even buy a new musical lovey that Edie can turn on herself. I'd leave a bottle of water where she can reach it (which they don't make cupholders for cribs I'll never know). I would definitely not change anything about her bedtime routine if it gets her to bed and asleep willingly, since the problem is waking up later. I would talk about what the night-waking routine is going to be. Amy, you and your partner are going to make this up, but have it always be the same thing no matter which one of you is doing it. I'd probably go with some variation of coming in and quietly shhing her, offering the bottle of water (to reinforce that it's in there with her) and helping her turn on the musical lovey. Then say goodnight and leave. She's going to cry, but it sounds like she cries whether you're in there comforting her or not.

I don't think this is going to work overnight. And I don't think the crying is the key part. I think the talking about it, and giving her other tools to help her sleep (the lovey and the water and the consistent routine of what happens when she wakes up), and talking about it, and talking about it is what's going to help her. Or maybe she'll just grow into sleeping, but you and I will think my advice helped you when in reality it did nothing the passage of time wasn't going to do.

I hope you can fix the situation by waking her up right before she usually wakes up, and don't have to go through any of the rigamarole of a middle-of-the-night routine.

It's amazing any of us survive to adulthood, isn't it? Courage.

* By "CIO people" I don't mean people who have done CIO. I mean people who tell everyone with a baby to do CIO or they're somehow missing out on the ultimate parenting experience and doing their kids a grave disservice. I'm sure you know them. They're probably waiting for you at the grocery store right now, standing next to the Give that Baby a Pacifier/Get Rid of that Baby's Pacifier people.

** But maybe not always. Remember how my second son was a "cries to release tension" baby, who'd even cry while nursing to sleep? Now that he's a toddler it seems that sometimes he cries to release tension, but sometimes crying gets him more upset. He also won't nap for me willingly. So every day's a crapshoot with him crying and me standing outside the door after 90 seconds trying to figure out if the crying is helping him wind down or just making him more upset. It's charming. I blame my husband, somehow.

Comments

[smashedpea]

My 17 months old daughter sometimes wakes up screaming in the middle of the night, too. Not at a regular hour like yours, though. It's more random and thankfully enough doesn't happen every single night.

Anyway, we found that talking to her about it really, really helps. We tell her a couple of times during the day that it's really not necessary to wake everyone up and that if she wakes up, she should just close her eyes and go back to sleep and that Mama is going to come get her in the morning.

The funny thing is that up to now, she's been very accurate in letting us know ahead of time what she was going to do. Every single time she's agreed to go back to sleep on her own beforehand, she actually did go back to sleep on her own (or we didn't even hear her wake up). The one time she shook her head no to this plan, she did wake up screaming and needed some help going back to sleep.

Not sure this works for you, but it did wonders for us. Good luck!

[hedra]

Don't forget to check for physical discomfort. My oldest woke and needed help going back to sleep for years. Years and years.

Turned out he had silent reflux and a kink in his spine. When he was really tired, he would go to sleep just fine. So bedtime wasn't a huge hassle. But when he'd slept enough that the balance of 'need sleep' wasn't big enough to eclipse 'body hurts', he was awake. He was content to be awake, too - he had been uncomfortable for so long, he considered it normal, and didn't register it as discomfort at all. But it still functioned as discomfort.

Same child had many other 'discomforts' that we slowly worked our way through. He was thirsty at night (sippy of water!). He was too warm (made the room cooler). He was hungry (a snack before tooth brushing). He was lonely (since he wasn't a cosleeping-friendly baby/child, that meant introducing a lovie). He also had night terrors, can't remember the age exactly, but they didn't last very long.

Gabe also had the random 'sometimes crying is a downcycle, sometimes it is an upcycle' thing. I could usually tell if it was escalating within a few moments, but I still had to wake and listen to be sure each time. Whee.

Gabe started sleeping through the night at 4 years old, after two weeks of chiropractic (his neck was twisted to the side badly enough that I didn't know how I'd missed that before!). Stopped snoring, and falling out of bed, too (he was an active sleeper - another sign that there's something physically uncomfortable going on). He was treated for reflux at about 6 years old, at which point he stopped waking up still tired. WOO!

Anyway, hope that gives you some ideas for where to look. (I also wouldn't rule out 'just not tired anymore' and reducing the amount of nap during the day...)

[(Un)relaxeddad]

Our dudelet went through a night terrors phase at around the same age and it's definitely worth checking for. Other tools we've tried on other occasions have included Rabbit Clock (a very strong visual clue that it's still sleepy time), CIO (worked at age eight months, not so much later). We've been lucky with broken nights in that it's been more or a less a phases thing - the most disturbed run of nights happened more recently (age 2 and a half) when he was disarraying his nappy and wetting the bed three or four times a night...

[Helena]

I just logged in to reiterate the reflux theory, I read a question-and-answer thing very similar to this (can't remember where), where the baby was waking at the same time every night and the main theory was reflux.

Oops, just googled, and it's from Askmoxie, January 26, 2006. . ."Q&A: waking in the middle of the night and screaming"
http://moxie.blogs.com/askmoxie/2006/01/qa_waking_in_th.html

[Charisse]

You know, it's not as dire or diagnosable as reflux, but this sure sounds like the way Mouse would behave when she was younger and had gas. Any seriously gassy food she ate --broccoli, beans, lentils, garlic--(or anything spicy I ate, since we were nursing) would result in loooong, fussy wakeups. Most other babies I know would just fart and be done with it, but Mouse would get really really uncomfortable, and she would wake up with this weird staring look and a lot of crying. The night of my Thai cooking teacher's 20th anniversary party was a memorable occasion.

Anyway,we starting giving her Mylicon at bedtime and making that the first thing we'd do if she woke up crying. It could still be a little rough, but usually within 45 minutes of getting a Mylicon dose and being cuddled (often with a gentle, clockwise tummy rub), she'd fart and burp a bunch and go back to sleep. Not perfect, but beats 2 hours anyway. It definitely improved with age--at 2 1/2 she still gets occasional gas, but she deals with it much better. If she's snarfed 2/3 cup of pinto beans at dinner, it's possible she'll wake up, but she'll just ask for a tummy rub and be down again in 15 mins.

(Funnily enough she was also a "wouldn't co-sleep if you paid me, but definitely nurse me to sleep" kind of kid. Maybe someday they'll find that and gas on the same genetic region or something.)

[Gretchen]

This sounds similar to what we went through a few months ago with our daughter - she'd wake up in the middle of the night, fuss for a while, then be wide awake and rarin' to start the day ... at 2 or 3am. She wouldn't go back to sleep no matter what we did - singing, rocking, cosleeping, CIO, nothing worked. What we finally ended up doing may not work for everyone, but here it is:

We childproofed the living H*** out of the first floor of our house. When our daughter woke up and wouldn't go back to sleep, I would take her downstairs, close off the stairs, give her a cup of water and her blankie, and lay down on the couch. She could play with whatever toys she wanted, but no Baby Einstein DVDs (boy, did that last part tick her off). I told her that when she got sleepy, she should come get me. Then I dozed on the couch while she happily played by herself and chased the cats around for as long as an hour. On one memorable occasion, her idea of playing involved climbing up on the couch and running the length of it - on top of me - trying to hit every sensitive spot along the way. I'd discourage that, if I were you.

After a while she'd get tired or lonely and want to snuggle on the couch with me. I'd let her snuggle there for a while, sometimes until she fell asleep, then put her back in bed.

I don't think this took any less time than our previous strategy, also known as "stay in bed listening to her scream and regretting we ever had children," but it's a lot less stressful, and my husband could at least get a nap upstairs while I (sort of) paid attention to our daughter.

I only had to do this for a week or so ... after that, she still woke up occasionally, but she'd go back to sleep if I rocked her and sang.

You'll know the end of the cycle is in sight when the kid starts waking up later and later, even if it's only by 15 minutes every night or two.

[Amy]

Thanks, everyone-- your responses have been extremely helpful. A few quick follow-ups:

1) We did think Edie had reflux when she was younger (maybe 2-3 months old or so) and her pediatrician recommended we put her on Zantac, which we did for a while, but were never convinced that was the "real" problem. The symptoms we saw-- refusing feeding or crying when feeding coupled with some swallowing/gulping that seemed like reflux, did not subside when she went on Zantac. Since we didn't see a relationship between the symptoms and the drug, we took her off of it, and eventually her feeding problems stopped. I'll have to read up on reflux, though. That's definitely a possibility.

2) She doesn't wake up at the same time every night-- sorry I didn't make that clear. It's completely random: sometimes 12:30, sometimes 3, etc.

3) We used to give her mylicon every night until she was about 1 year old and stopped when she moved to real milk (not sure why). We'll try to start that up again and see if it makes a difference.

4) I'll check into the night terrors info. It does sound like her post-waking behavior kind of matches this.

Last but not least: this is probably 100% coincidence, so I'm not counting on any magical cure after our one night of cry it out, but the night following that three-hour off/on cry session was much, much better. We'll see how tonight goes.

Okay, thanks again!

[Amy]

oops...forgot to say that I'll definitely start talking to her about middle-of-the-night issues. She's extremely verbal and vocal, so talking her through this may be key to solving this problem. Thanks.

[hedra]

Reflux treatments are very individual. Zantac worked breifly for Gabe, but then stopped working. It works very well for his sister Meriel. Some kids get no benefit from it at all. Others it is a wonder drug.

If she had typical reflux signs, I'd definitely look into another type of med for a trial. Silent reflux (no obvious symptoms but definite damage) is far more common in kids with early childhood reflux than many people think! Even if the CIO helped, I'd check out reflux issues - it can show up again later with feeding/eating disorders, or serious erosions (and those can still be without obvious pain). Better to be sure, if you can.

JMHO.

[Mary]

We recently went through something similar with our year-old. I couldn't manage to comfort her when she woke (we had night weaned, so that wasn't on the table), so I figured, she's crying anyway, it won't *hurt* anything to come in, make a few comforting gestures, then leave (rinse, repeat, a few minutes later). What helped us a lot was to use a precise script *every* time we put her to sleep and every time we came in to comfort her in the middle of the night--it doesn't matter what, we said "It's time to go night night, you're a big girl, it's OK, you can go to sleep"--but it should be the exact same words every time. For some reason, this really clicked with her--she knew what was going on and what was expected of her after the first few times. I don't think she ever felt abandoned or scared through this process. Maybe a little ticked off :) She still woke early for a month or two but recently has been sleeping until 5:30-6!!

Good luck. I hope you get some sleep soon.

[Alexis]

My son started waking in the middle of the night when he turned 2. I'll need to go to his bed and sit by his bedside until he falls asleep. However, when I had my second baby when he's two and a half, I knew that I couldn't do that anymore since I'll need to be with the baby. So, we decided to let him cry to sleep. But, the baby is already 4 months old and my elder son is still waking in the middle of the night and would cry for about 1 hour before he goes back to sleep. In the morning, he would wake up much earlier than he used to and cry for me again. Then, only then I will go to him and stay in the room with him until he falls asleep or till he decided to get out of bed. We have no idea what to do anymore since letting him cry to sleep is not working for us. I think he might be losing his voice soon with so much crying. Please help.

[Paola]

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Thanks for the help :-), Paola.