Bedtime routine helps babies sleep through the night

DEAR DOCTOR K: My 9- month- old is still waking up three to four times during the night. How can I get her to sleep through the night?

DEAR READER: By the time a baby is 4 or 5 months old, he or she is capable of sleeping through the night. We tend to think of "sleeping through the night" as a long stretch of uninterrupted sleep. But in reality, all babies wake up during the night. Some discover their own way of comforting themselves and getting back to sleep. Others must be taught.

Different experts recommend different techniques for helping your baby get to sleep and then to sleep through the night. Ask your pediatrician what he or she recommends, or do some research on your own to see which technique best fits with your parenting philosophy.

Despite the differences, most experts agree on the following points:

— Establish a consistent daily schedule of sleeping, feeding, bathing and playing times.

— Babies benefit from a regular bedtime routine.

— A good sleep environment consists of a dark ( but not too dark) and quiet room.

— A transitional object, such as a soft toy or blanket, can help an older infant fall asleep.

— A baby should be put to bed when drowsy, but not yet asleep so she can learn to fall asleep on her own.

— Make nighttime visits boring for your baby. Feed your baby if she is hungry, but not if she is looking for comfort. Change her diaper if it is soiled or very wet. Otherwise, offer only a minimum of stimulation.

— Let a fussy baby lie, and see if she falls back asleep on her own.

— If your baby is accustomed to nighttime feedings, eliminate them gradually by increasing the time between them over several nights.

Even babies who learn to sleep through the night may go through periods of night awakenings, particularly around 8 or 9 months old. "Separation anxiety" first appears at this age. This is a time when your baby is learning new motor skills, such as crawling, sitting, standing and climbing. Being separated from you, combined with the excitement of practicing her new skills, may interrupt your baby's normal sleep pattern. Consider calling to her, rather than stopping in to soothe her. Some babies benefit from having their nursery door kept open a crack, so they can hear you.

A patient of mine whose first baby was not a good sleeper once asked me if that meant that the baby would continue to have sleep problems later in life. I checked with a pediatrician colleague. I learned that young children ( older than infants) and teenagers indeed can have sleep disorders like those that affect adults. That includes difficulty falling asleep or staying asleep, sleepiness during the daytime, snoring or abnormal movements and behaviors during sleep.

Fortunately, these sleep problems are no more likely to occur in kids who were fitful sleepers when they were infants. That's one less thing to worry about as you are wondering if you'll be allowed to sleep through the night!