Month 9 Worry: Why Is Baby Suddenly Waking Up Nightly?Dr. Greg Germain, MD
You’ve gotten very attached to your little one, of course. She has a personality, a hairdo, a contagious laugh. So why is it that you suddenly dread the sound of her cry at night?
Many parents of nine-month-olds ask me, “Why is my baby waking up nightly all of a sudden? She’s been sleeping through the night so nicely for so long!”
What’s the Issue?
By nine months of age, the large majority of infants are sleeping through the night. But if your perfect sleeper is suddenly demanding curtain calls, you are not alone. A mix of issues play a part in night waking around this time of infancy.
Consider the Numbers
The average nine-month-old sleeps 14 hours per 24 hours. This is usually divided into a through-the-night sleep of 10 to 11 hours and two naps of at least one hour each during the day. But research shows that 20 to 30 percent of infants at this age are waking at least once per night. (All three of my kids fell into this minority. It prompted me to read lots of sleep books!) It may be a transient phenomenon or you may have a baby that, with rare exceptions, has never made it through the night without needing your intervention. In either case, rest assured you and your baby will have rest again.
What Parents Can Do
An understanding of your infant’s stage of development and an organized game plan usually help this messy situation. Because while she can babble, sit up, and certainly cry to express some of her wants and needs, your nine-month-old is far from efficient at expressing complicated thought. And sleep disturbance seems complicated. Understanding your baby’s stage of development is step one in understanding the problem.
An infant at nine months of age has achieved two developmental milestones which may interfere with independent sleep:
- First, babies have developed object permanence by now. If you take a pen and hide it under a piece of paper, a four-month-old thinks you have made it disappear! A nine-month-old knows to lift up the paper and find the pen underneath. Similarly, a nine-month-old who sees you leave the room during your bedtime routine knows that you are somewhere behind that door. And she knows that there are things that she can do to get you back in the room. Crying is an infant tried-and-true mode of attack.
- Second, infants at nine months of age are often going through a major stage of separation anxiety. Infants can be quite clingy and need lots of reassurance at this age. Many a parent has complained that going to the bathroom without his or her baby glued to the hip is impossible. The intense separation fear that can bubble up at bedtime, then, is understandable.
But once you give your child the developmental benefit of the doubt (and before you decipher her specific sleep issue), consider her nursery’s safety status. An awake baby is more mobile than a sleeping one, so remember:
- Lower crib mattress to its lowest level.
- Keep rooms at modest temperatures (68 to 72 degrees is ideal) and babies from being overbundled (as overheating is a SIDS risk factor).
- Avoid lots of toys in the crib.
- Remove crib bumpers and quilted blankets (due to SIDS risk), plus crocheted blankets (which may have loose strands that could choke a baby).
- Never allow smoking in the house.
What the Docs May Do
When I discuss this issue with parents in the office, the first thing I do is to walk through their bedtime routine with them: “What do you do? And don’t spare the details.” It turns out that at this age, the last part of the bedtime routine is critical. Infants at nine months can make strong associations with their environment at the time they fall asleep. So an infant who falls asleep rocked and cuddled, can grow to need that rocking and cuddling to fall asleep. Because infants wake and return to sleep many times each night, your bedtime routine can result in an extra effort on your part (rocking and cuddling, in this example) many times each night as your infant wakes up and doesn’t know what to do with himself.
Feeding, like motion, is another example of a parent-provided stimulation. For infants who bottlefeed or breastfeed as they fall asleep every night, I encourage parents to move the feeding to an earlier part of the bedtime routine. Instead of bath, tooth brushing, reading, feeding, then bed, I suggest feeding, bath, tooth brushing, reading, then bed. Pacifier use, white noise, or bright light in the room during sleep initiation can cause a similar problem. This issue of “cleaning up the bedtime routine” teaches your infant self-settling—a developmental task that all babies must learn.
Your pediatrician can discuss with you the many ways to promote self-settling. There is The No-Cry Sleep Solution method by Elizabeth Pantley or the Solve Your Child’s Sleep Problems method by Dr. Richard Ferber, MD. These methods get to the same end point but with different pros and cons. My favorite book on the subject is Dr. Marc Weissbluth, MD’s Healthy Sleep Habits, Happy Child. Dr. Weissbluth’s book helped me through three sleep-deprived infancies.
Your pediatrician may ask you to keep a sleep diary. This is a detailed log of every fall-asleep time and wake time (including naps) over the course of a week. Oftentimes sleep logs are full of information that helps your pediatrician get to the solution more quickly.
More 9th Month Health Help
- What was last month’s most popular health worry?
- Learn which medical question you might have next month.
- Here’s what else is happening with your baby’s health and development this month.