Brooks' Story
I met this little man at 14 weeks old, as a nanny client. Mom would soon be headed back to work and needed a bridge of care until daycare opening at 6 months. His routine was spot on for naps and bedtime. They had a great routine and environment already in place. The only obstacle that I found was, he was still in a swaddle sleep sack AND sleeping in a Dock-A-Tot in the crib. Mom was not looking forward to transitioning out of either, because she knew that it would likely disrupt how well he slept since he was comfortable and doing well with these in place. He was also waking at least 1, sometimes 2 times per night for a short feed, and woke for the day super cranky between 6:15-6:45 and not terribly interested in eating a full bottle, which was starting his day a bit off.
The first thing we discussed was safe sleep. The Dock-A-Tot is not only considered not safe by AAP, but also by Consumer Safety Commission, due to suffocation risk. Being swaddled past 16 weeks is also considered unsafe due to imminent rolling, and since it suppresses the startle (Moro) reflex and the intensity is lower after 12 weeks, we decided that I would begin the transitions immediately. He was also being put down drowsy-but-awake and had a loud sound machine and a timed shusher, along with a completely black-out darkened room. Knowing that he would be going to daycare soon, and black-out is not an environment the daycare can legally duplicate, we decided to tackle that at month 5.
We immediately removed Dock-A-Tot, and took right arm out of swaddle for first nap of the day. I put him down awake for sleep with sound machine and black-out, and shushed him while my hand was across his belly until I knew he was calm and settled. I remained with him in case he needed more support, then left when he was almost asleep. This is a pattern we repeated at bedtime as well as naps and he adjusted well a couple of days later when both hands were free. Within days, there was no fussing after placing baby down awake and he was very comforted having his hands free. Within a month, he would roll to belly every time he was placed in crib and fell asleep much sooner than even being supported to sleep in the first days of working together.
As far as increased night wakings and feeds, I recommended we reduce the night feed frequency and hold him to the 6-7 hours we knew he could sleep without a feed, suspecting that some of the wakes were now habitual rather than hunger. We knew he was capable of longer stretches of sleep, since he had done that regularly just a couple of weeks before. Non feed wakings were handled with hand on belly and shushing while remaining in sleep space (crib) without light or added stimulation (otherwise this would enforce the habit). Once we were back down to one feed per night, we could, and did, determine if this feed was necessary by paying close attention to the quality of first day feed. Then the work began of shifting calorie intake from nights to days. At first, this was accomplished by adding an ounce to the last 3 bottles of the day, to ensure he had more calories before bedtime. Then we reduced the middle of night feed by 2 ounces. This shift continued over the next few days, and before 20 weeks, he was sleeping 7pm to 4 am every night, getting a small bottle, and waking happy and ready for a full feed between 6:30-7:15.
This is a perfect example of how a 4 month sleep regression can cause a snowball effect and become habitual due to parents regressing afterall, most sleep regressions are regressions in parents response to the wakings and behaviors.