10th September 2018

Surviving Sleep Regressions

There is very little clinical literature on “sleep regressions”, yet ask any parent their experience of this sleep phenomenon and the fear in their eyes will be very real indeed! 

Personally, I try to avoid the term “regression” as it makes it sound as if things are going backwards and actually the opposite is true – whilst sleep does typically deteriorate during these tricky periods, they happen because a little one is taking huge strides forward in their development, which is something to celebrate rather than fear. It is also very possible to equip your child with the skills they need to steer past these sleep landmarks as confidently and successfully as possible.

Anyone who is familiar with the amazing parenting resource, Wonder Weeks, will know that there is surprisingly commonality in terms of a child’s development by age. This is why we see sleep seeming to take a backwards step (or fifteen!) at certain month-markers, beginning as early as a baby’s fourth month…

The 4-month sleep regression

Of all the sleep “regressions”, this is the most poorly named! Firstly, it takes place anywhere in the first 6 months and whilst month 4 is a common time, it’s as likely to occur at 3 or 5 months. Secondly, of all the changes in a little one’s sleep that are termed as a regression, this one should in fact be called a “sleep progression”.

Newborn sleep is wonderfully simple! Tiny babies flit from awake to fairly deeply asleep with not much in between. Yes they initially wake frequently for feeds and cuddles but generally speaking they can be put down already fast asleep and ultimately stay that way for 6, 7 or even 8 hours overnight. I remember feeling pretty smug when my little boy was sleeping in a glorious block from 10pm to 6am round about 12 weeks! And then literally overnight, he started waking every hour or two. Why? Because they way he slept had changed. It had matured, like so many other aspects of his development and it signalled that he had begun to sleep like a child rather than a newborn.

Once this change occurs, instead of quickly slipping into deep sleep and staying there, a little one begins to sleep in a more organised pattern, cycling through periods of lighter sleep every 45 minutes to an hour. During these phases, a baby becomes more aware of his environment – and is likely to notice if something is different to when he fell asleep. Inevitably, babies who have sleep crutches or associations such as being rocked or fed-to-sleep are hardest hit by this heightened awareness. As an example, a baby who falls asleep being cuddled by daddy will enter light sleep and become aware that he is somewhere very different to daddy’s warm chest with its heartbeat and snuggly arms. The unfamiliar environment will drive him to wake and once awake, a little one who is rocked (or fed) to sleep will seek that help to resettle – because that’s what falling asleep looks like to him.

Whilst a child with such sleep associations may be able to link sleep cycles together some of the time, he won’t be able to do so consistently, particularly in the second half of the night once the tiredness is less of a factor in keeping him asleep.

How long does it last?

There is often a particularly fussy stage for a little one around the time of their maturation in sleep pattern and this typically lasts for a week or two. The change to how their sleep is organised, however, is permanent. For this reason, a little one who can only fall asleep being rocked or fed, effectively won’t recover from this “regression” – they will need their sleep crutches until they learn a different way to fall asleep. However, in the midst of the fussy stage isn’t the time to begin teaching him the skills he needs – whilst hourly wake ups are undoubtedly hard for the parents, they are hard on a little one too; his whole world and way of sleeping has fundamentally shifted – it’s not a wonder he’s unsettled and looking for more parental reassurance than usual!

Springing forward

Once the worst of the fussiness has passed and your little one becomes more settled during the daytime, it’s a great time to start gently shaping their sleep so that they gain the skill and confidence to navigate through sleep cycles. This means weaning off a reliance on being rocked or fed-to-sleep. To be absolutely clear on this point, I am by no means saying that little ones of this age don’t need night-feeds, or even night cuddles – many do and that is very biologically normal – but work on the feed/cuddle and the resettle to sleep being separate events. The plan to improve sleep should be gentle and gradual. I would never advise a parent to go from rocking or feeding their child sleep to putting them down and walking away – that’s a huge step and likely to result in a lot of crying which is something we can avoid by taking smaller steps towards more independent sleep.

After the challenge of a child’s sleep maturing, things usually have settled down a little and a family may well have enjoyed a few months of restful nights. But there are several other tricky periods looming! In fact, they come fairly thick and fast…

 8-10 months

There is a consistently challenging time with a little one’s sleep somewhere between months 8 and 10. There is a lot going on for a baby developmentally in this window and it’s barely surprising that sleep is often affected. Often little ones are crawling and beginning to pull themselves up, both of which involve huge gross motor development. They may also be rapidly developing their language and communication skills. Additionally, separation anxiety often kicks in with a vengeance at this age which can make sleep even more challenging for a little one who wants to be near his primary caregiver pretty much all of the time.

With periods of rapid development tend to come more night-wakings. This is often exacerbated by a deterioration in daytime sleep causing a little one to be overtired. A child who is able to resettle a night-waking independently will typically be less noticeably impacted by this development-driven interference with sleep whereas the parents of a child who needs help to fall asleep will definitely notice being called upon to resettle their little one multiple times throughout the night.

As if this period of rapid development isn’t enough to unsettle a child, it is also the time when most drop their third nap. Whilst the three-to-two nap transition isn’t usually too troublesome for a little one, if the two remaining naps aren’t quite long enough and/or the timings aren’t adjusted to balance out the day’s awake periods, this can result in overtiredness which is often the straw that breaks the proverbial camel’s back, making already tricky nights feel unbearable.

11-13 months

Parents often report a deterioration in sleep somewhere around their child’s first birthday. For many little ones, this tallies with mastering the skill of walking, which of all the physical milestones typically has the most noticeable effect on sleep. Extended night-wakings are common around this time as a little one may either lie awake trying to work out how to walk or actually having a practice, despite it being 3am and him being in a cot!

As a little one can become tricky around their naps during this period, parents may (entirely logically) take it as a sign of readiness to transition to one nap. However, the two-to-one switch can be challenging and a child is rarely genuinely ready to make the drop until around 15 months. The earlier a child drops to one-nap, broadly the less likely they are to manage it smoothly and the bigger the risk of overtiredness making the nights even more difficult.

The key to managing both of these challenging periods is to have equipped your little one with the skills and confidence they need to resettle independently before the milestones hit. As with the four-month “regression”, if your child isn’t able to resettle without help, in the midst of these tricky periods is not the time to start teaching them. Often, when a child’s sleep has been reasonable for a spell and then a real fussy stage hits, parents believe their little one is acting up or being difficult around their sleep. This can then be a motivation to “sleep-train” – often switching from rocking or feeding-to-sleep to leaving their little one alone to cry. The step between these two extremes is huge and will be particularly hard on a child who is in the middle of a development leap and/or experiencing separation anxiety.

The best advice is to work on your little one’s sleep prior to the unsettled time at 8-10 months or immediately afterwards in preparation for the 11-13 month challenges. If this has not happened then I typically advise parents to weather the worst of the developmental storm and then set about helping their child learn how to sleep well. For little ones who are used to being held, fed or otherwise helped to sleep, a gentle, gradual process will be the most appropriate way forward.

18 months

Whilst there is a lot of anecdotal evidence of a regression at this age, in my experience, any challenges arising are more to do with a little one’s emerging independence and a testing of the boundaries than genuine sleep interference. I always advise parents to remember that bedtime and sleep not take place in a vacuum – hence daytime behaviour will impact what goes on at night. This applies to the parents and their child! A little one who is testing the daytime boundaries is likely to do so at night – by association, children typically expect consistency from their parents so if they see that in the daytime, a parental “no” actually means, “OK yes if you shout loudly enough”, they will pretty inevitably expect bedtime boundaries to be similarly flexible. 

It’s not uncommon for separation anxiety to re-emerge around this age. Again, a parent is likely to see evidence of this during the day as well as at night. Usually, the smoothest way through challenges around this age is for a parent to provide extra comfort and reassurance if it is sought whilst maintaining the boundaries. Similarly, if a child is night-weaned parents should avoid feeding back to sleep in desperation – otherwise there will be a battle when the night-time milk is withdrawn.

2 years

Anyone who has parented a two-year old will know they can be tricky – and not just around their sleep! Most two-year olds go through a phase (or phases!) of not wanting to nap. Yet, most little ones really do need some daytime sleep until at least their third birthday and those who drop the nap earlier often see their night-time sleep adversely affected. It is advisable therefore to treat nap-refusal as a temporarily glitch – to keep offering the nap and working on the basis that it is needed.  

This is a time of genuinely huge transitions for a child – potty-training, the move from cot to bed and for many little ones, the arrival of a sibling, all of which can impact sleep. Wherever possible, I advise parents to keep their child in a cot until they are at least two and a half. It’s not until around this age that a child really grasps the concept of “staying put” and so a move into a bed that doesn’t have sides is likely to mean a lot of time spent returning a little one to their bed. Of course, safety takes priority and if a child has become skilled in scaling out of their cot then the move to a bed may be necessary but as a general rule, a cot-escapee will transition smoothly into a bed-absconder and so if there is a way of keeping a little one safely in their cot that is usually the best way forward.

Finally, boundaries really matter to a two-year old so the best approach is to not say anything you don’t mean or won’t follow through – no matter how frustrated you are! You will find things settle more quickly if boundaries are gentle, fair and utterly consistent.

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Lauren Peacock - Sleep Specialist - UK
Book a free 15 minute introductory phonecall
07977583728 | lauren@littlesleepstars.com