The Four Month Sleep Regression: What is it and What can be Done About it?
At Baby Sleep Science we don’t like the term “four month sleep regression,” because the changes in sleep that occur between 3-4 months aren’t really a regression at all; they result from a permanent change in sleep architecture.
The Science: When a baby is born, sleep is immature and constant. A healthy newborn (free of colic, reflux or other medical concerns) will sleep until one of three things happen 1) hunger, 2) another need (wet/dirty diaper), 3) sleep is no longer needed. This pattern is difficult at first, but for most families sleep unfolds as you expect it to – your baby begins life with fragmented sleep and frequent feedings. Virtually every parent is prepared for disrupted sleep at this time. Over the course of the first few months or so, the interplay between the three waking factors and sleep are intuitive. As you get to know your baby, you start to learn when he’ll be sleepy and you anticipate that need. As your baby needs less frequent feedings, he’ll start to naturally sleep longer stretches during the day and at night. These stretches might start with three hours, but then over the course of a few weeks they grow to four hours, then five hours, and so on. Some lucky parents might even see their baby naturally sleep through the entire night during this time (10-12 hours straight!). This is a beautiful progression that feels very natural and appropriate.
Unfortunately, Mother Nature is quite the saboteur and somewhere around 3-4 months everything changes. Everything. Around this time, sleep matures, so that instead of sleep being a constant state, it becomes dynamic and your baby will start to go through different types of sleep, called sleep stages. Sleep stages follow a predictable order that flow together in sleep cycles. These sleep cycles last about 60-90 minutes during the night (sometimes 120 minutes as they are developing) and are marked by a brief waking that happens at the end. This brief waking is the cause of most “sleep problems.” This waking is meant to be protective (adults have it too). It allows your baby to briefly check in with the environment and ask, “Am I ok?” When we fall asleep, we expect our conditions to remain constant throughout the night, so if your baby has fallen asleep in your arms and you transferred him to the crib, the crib will feel wrong when he hits the checking wake up. This means that after every sleep cycle your baby will probably wake up and you can interpret his cries as, “Hey Mom! Dad! Something is wrong here!”
If you don’t know that this sleep “regression” is coming, then you’ll probably do what you normally do when your baby wakes up – feed him. Since that’s how he knows how to go to sleep, he’ll fall back asleep for another hour or two and then he’ll wake again and you’ll feed him again. After a few nights of this, you’ll convince yourself that this is a growth spurt or teething or your child getting sick, but the waking usually doesn’t resolve on its own (hence the reason “regression” is the wrong term). At this point you’ll have reinforced that feeding is the way to get to sleep and your baby will have started to take in more calories during the night. This means that his wakings now have a dual nature 1) he’s waking due to the sleep association, but 2) he’s also now genuinely hungry at night. Many babies get stuck in this reversed feeding pattern, because another change that happens around four months is that most babies become very interested in the world and become very distracted during daytime feedings. This reduction in daytime feeding paired with increased night feeding means that you’re stuck in a pattern that can be difficult to fix.
What can be done about this?
If your baby is under 3-4 months and hasn’t yet had a sleep regression, then the best thing you can do is give your baby practice falling asleep in the place where you would like him to sleep. Start a little nap and bedtime cue (singing a specific song, rocking, bouncing comforting) and when he’s tired, put him in his sleep space awake. He may be confused and frustrated by this and that’s fine, just pick him up and repeat your sleep cue. You can rock/nurse him to sleep or you can try to put him in the crib again, awake. At this point in a baby’s life you shouldn’t try to force the crib if your baby isn’t ready to fall asleep there on his own, but you do want to teach him that the crib is a reasonable place to sleep. If he never even has the chance to fall asleep there, then there’s no reason he should accept the crib, from his perspective your arms is the right place to sleep. In little babies it’s all about offering the chance; you don’t have to do it every day or at every sleep bout, but it is important to think about this and start to make change in anticipation of the 3-4 month regression.
You certainly don’t want to deny your baby feedings when he is hungry, so it can be really difficult to disentangle true feeding needs from sleep associations, but it can be done if you pay close attention to your baby’s pattern. If your baby normally sleeps from 7:00 PM – 1:00 AM, eats and then sleeps from 1:00 AM – 4:00 AM, eats and then sleeps until 6:00 AM, then you have a good sense of his true needs. If one day somewhere between the 3-4 month mark he’s up at 1:00 AM AND 2:30 AM, you can begin to suspect that this might be the beginning of the “regression.” If your baby hasn’t suddenly increased daytime feeding (which would indicate a growth spurt), then it’s probably the regression creeping in on you. Since you can feel pretty confident that your baby doesn’t need to eat at both 1:00 AM and 2:30 AM, this would be a good time to teach your baby to go back to sleep in new ways. For example, feed him at 1:00 AM as usual, then simply rock, bounce or hold him until he goes back to sleep at 2:30 rather than feeding him. The goal is to teach him that there isn’t just one way to fall asleep and to keep his nighttime calorie intake stable. The rocking can also become a sleep association, so if your baby continues to wake up and isn’t hungry, but wants to be rocked to sleep, use the suggestions above to teach him that the crib is a reasonable place to be (offer the sleep cue, put him in the crib awake, pick him up and offer the sleep cue, put him in the crib awake).
If your baby is going through the 3-4 month sleep regression, then you need to evaluate the extent of the problem. Is your baby really eating a lot more at night than he was before the regression? Is he eating a lot less during the day? If so, then you will need to taper his feedings at night (see our blog on gentle ways to reduce night feeding), before doing anything else. If your baby is really hungry, you don’t want to ask him to go to sleep – he will be frustrated and so will you. First, determine how long he eats (or how many ounces he’s taking if bottle feeding) and just reduce his “extra” feedings a little each night. During the day, make sure you feed him in a quiet distraction-free environment in order to ensure he gets nice full feedings. Consider cluster feeding at the end of the day in order to ensure he has had ample opportunity to eat as bedtime approaches. Once he’s just eating a tiny bit or for a very short duration, you can start rocking him through those extra wakings rather than offering a feeding.
During this process, you will need to start putting your baby in the crib awake at bedtime (you can use the simple strategies that we described above). Also like mentioned above, some babies will develop a sleep association with rocking, so once you’ve reduced the “extra” feedings you can start to break up the rocking by returning your baby to the crib awake. The suggestions that we outlined for “not yet regressed” babies will work to teach older babies to go back to sleep too. Depending on your baby’s age, you may be able to do something a little more structured at bedtime and during the night if you want the process to go faster. We generally don’t recommend really aggressive sleep training for babies going through this regression. We also don’t think there is one right way to do sleep training. You may opt for a fast approach or you may opt for a very gradual adjustment. Your parenting style matters and there are many ways to get to healthy sleep. Check out our thoughts on that here.
A final note: If your baby is able to put himself to sleep at night and he’s still waking several times a night to eat, then it’s probably because his body is expecting calories at night now (the four month regression led to an increase in nighttime calorie intake and now they are “stuck”). That said, sometimes a baby can fall asleep independently and have a sleep association hang on during the night. This is why sleep is so hard! There isn’t just one thing that causes trouble. Sleep problems are usually caused by complex layers of issues and developmental changes like the four month regression cause new issues like extra night feedings. Please check out our other blog posts to help with your problem solving.
The four month regression can be prevented if you are aware that it’s coming and plan for it. If your baby has already gone through it and sleep is crazy as a result, then rest assured that life can go back to normal. We hope you find these suggestions helpful, but if you feel your situation warrants a more personalized plan, then book a consultation with us and we’ll help you through these tough times.
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© 2014 Baby Sleep Science: Sleep Resource Center