Our baby won't nap!

Our baby Jamie is four months old.  It seems like he is only happy when he's being held (or nursed), and I'm so exhausted I'm getting desperate.  Every time we put him down he screams, even if he's just fallen asleep in my arms.  He never sleeps more than ten minutes during the day, unless we're driving in the car or taking a walk. He’s sleeping pretty well at night (only up twice to nurse) and seems very happy when he wakes up in the morning. But for the rest of the day he gets progressively more tired and cranky, so we know he needs more sleep  What can we do?

Even when a four month old baby is doing well with nighttime sleep naps can be a challenge.  A  four month old baby is more aware of his surroundings and is actively watching. listening, and interacting to stimulation every waking moment.  At the same time, he needs a lot of sleep to accomplish his other important work: growing!  In between sleep and play, of course, he has to eat, and he needs a lot of calories to get him to the weight most babies achieve by their five month birthday: about two times their birth weight!

There are different ways to handle the round the clock needs of a growing baby like Jamie.  Talk to enough parents and you’ll get head spinning advice, much of which will be based on the other parents’ experiences (or memories) from their own babies. Some of the advice can be quite judgmental, leaving a new parent to feel that anything she does is likely to be bad for her baby.

I always ask parents to think about what they are observing about their baby’s  behavior and mood throughout the day to decide whether they need to make changes. From what you are saying,  you and Jamie are both having a hard time right now.

Let me describe the typical day of an overtired baby, and you decide if it sounds a little or a lot like Jamie’s day.

Jamie wakes up in the morning, alert and hungry, and you feed him. He should be hungry at the first feeding, which might be anytime between 5 to 7 a.m. (If a baby is feeding frequently at night, he might not be hungry. That would tell you he hasn’t yet developed a day/night pattern, which has to happen before you can expect a baby to develop a daytime nap pattern.)

After Jamie’s first feeding he's probably cheerful and alert and happier than he is at any other time of day.  After about twenty to thirty minutes, he probably starts to fuss.  You play with him, change him, and he seems happy, but after another ten to fifteen minutes he's fussing again.  You do your best to distract or play with him, but after five minutes he's still unhappy. Now you wonder if he might be hungry, so you nurse him.  

The feeding calms him down, and he may even doze for a few minutes.   Unfortunately, if you try to move him, he wakes up and now, instead of being alert and happy, he's alert and a bit fussy. Guess why? That fussiness you thought was a sign of hunger was actually his way of telling you he was ready for a nap. By the time you were done feeding him, he had had a tiny rest and was no longer sleepy. For the rest of the day, he has more and more periods of fussiness, although if he manages to take a long nap, he’s cheerful again. You've noticed that if you take him out for a drive or walk he’ll sleep for a while as long as you keep moving.  If you keep him in motion until he wakes up naturally he might even sleep for an hour or more.  Then, after that nice nap, he's cheerful again, just like he was in the morning, perhaps for an hour or more.

If this sounds like Jamie’s day, the problem is that he is both overtired and over stimulated.  Although he's learned to comfort himself briefly by feeding, (kind of like having a candy bar when you’re tired) he can’t get enough rest just dozing in your arms.  It's only when he has the constant, even motion of the car or walk that he can relax enough to have a restful sleep.  That's why he's cheerful after a long ride - he's not overtired any more.

There are different solutions for your situation. It would be a good idea to choose one of them because being the constantly exhausted mother of a constantly fussy baby isn't good for either of you.  Much of your baby’s emptional experience is connected to his interactions with caregivers who are tuned in to his behavior.  Tired parents are sometimes tuned out parents, even when they are holding their babies.

The first solution might not ideal for the long term, but many parents do this, even though they might not admit it. Plan your day so that you go out for a ride or walk at least three times every day, starting each walk or ride after Jamie has been awake for about an hour and a half to two hours after waking from his last nap.  Keep moving long enough for Jamie to get an uninterrupted nap, anywhere from 45 minutes to an hour and a half. (A swing is fine, but try to avoid having it be the only way Jamie sleeps, since he will eventually outgrow it!) You'll be able to tell if he's getting enough sleep because he'll usually be much more cheerful (remember that all little babies fuss and cry some, especially in the evening).  You can begin with this solution just to get a feeling for how much sleep Jamie needs and what he's like when he's not tired. Even though it’s a short term plan, you can get Jamie on a schedule that will help you start a more regular nap plan for him.

If Jamie can stay asleep in your arms, that’s another solution, as is lying down in your bed with him, as long as you don’t leave him alone.  This solution is definitely temporary, and may not work after a few weeks or months. But at least you’ll both get some sleep.

Both plans will help Jamie learn to have longer and more predictable daytime naps.  At the same time he’ll be developing an awareness of how good it feels to not be tired all the time!

Keep a record of Jamie’s wake up and going to sleep times in order to look for patterns.  Some babies are more irregular than others.  That’s just how they are wired.  In order for them to get enough rest, parents have to be very watchful for cues that they are almost ready for sleep and start the next nap within five or ten minutes.  After a while, you’ll know whether you will have to impose a schedule or whether Jamie’s internal rhythms will do that for you. Most four month olds need to sleep often, and are usually ready for a nap after 1 1/2 to two hours of awake time.

It is also helpful to try to space out your baby's daytime feedings so that he fills his tummy up instead of just grazing all day.  If you have an abundant milk supply, you will find that if you wait longer between feedings, he will eat more, which stretches his capacity--and a full tummy makes it much easier for a baby to sleep longer.  If your milk supply seems to be enough but not too much, don’t spread our the feedings too quickly and make sure that he seems satisfied.  Ideally, a baby this age will feed at both breasts at each feeding.  In between, he might nurse for comfort, but he won’t be grazing all day. ( Of course, if a baby and mom are cheerfully maintaining a grazing nursing style that is fine--this advice is for moms whose babies are not sleeping!)

Once you have Jamie on a more predictable schedule, he’ll be happier and so will you.  You may decide that you don’t have to make any more changes.  If the  solution isn’t enough, either because it is too much work or because even with the different attempts to keep him moving you are still seeing a tired baby, your only other option is to help him learn to sleep in his crib.  If you do decide to move to this solution, you have to be very, very patient and be willing to put up with Jamie being unhappy as you make the transtion.

Each morning, after Jamie has his happy and alert period and starts to descend into his fussy time, instead of feeding him until he falls asleep, nurse for just a few minutes without letting him fall asleep.  Then take Jamie the room where he usually sleeps, which should be dark for napping, and then put him in his bassinet or crib while you say or sing words of comfort. Sit next to him, sing to him, or pat him. Since he's not used to this, he'll probably begin to fuss, complain or cry.  This will be very hard on you!  But let him fuss until he falls asleep.

If Jamie is really mad about your doing this, he may start to cry hard. You can pick him up to soothe him and then settle him down again. But if he’s sleepy, you’ll quickly find he’s not crying just because he want to be held--if that were the case, he’d calm down and be cheerful when you pick him up. He's probably crying this way because he is exhausted! Instead of repeatedly picking him up to soothe him, try to use your voice or just pat him.  After he’s gotten as upset as he needs to get, he’ll peak out and then he'll fall asleep.

Many new parents feel that this process is too uncomfortable for them or their baby. In my experience as an infant sleep consultant, naps are always a bigger challenge than nighttime sleep, and sometimes parents would rather wait it out than tough it out.  If you feel that way, you don’t have to do it! Just stick with the motion approach. As long as Jamie sleeps that way, he’ll be fine. Parents usually make the decision to try something new when they feel that what they are doing isn’t working. My feeling is that if a tired baby is fussy and unhappy much of the time, the whole family is under stress and the psychological consequences can be worse than the short term stress of crying when they fall asleep at nap or bedtime. An exhausted baby is often labeled as "difficult" and that label can affect the way parents feel about him. 

The best way to tell if what you are doing is working is to look at your baby and see how he acts when he has had a chance to sleep.

See what works for you and Jamie together.  If you make changes, you can do so gradually, or ask friends and family members to help you out.  Every month Jamie will be better able to self regulate, and although most babies and children need some type of parent imposed structure in order to eat and sleep well, each month will make it easier.  Just make sure to get all the help you need to stay rested and healthy yourself.

 Meg Zweiback is a peciatric nurse practitioner and an infant sleep consultant in Oakland, California