When to Call a Pediatrician About Your Baby’s Sleep

Every person is born unable to sleep all night. And yet, every healthy baby will achieve the ability to sleep through the night not too many months after birth. Really.

Still, all parents experience that infamous drain of no sleep for weeks to months after a baby is born. Some regain sleep in the first year, some not for many years.

What is all this about? How can you maximize the chance you will sleep again through the night before half a year passes after birth? And when should you be worried enough to call a pediatrician?

The fact that every baby born cannot sleep all night, and essentially all of them will be able to do so not long after birth hinges on two key facts. First, a newborn’s brain does not have matured sleep cycling to allow for 8-12 hours of sleep in a row, meaning their brains wake them up. The second factor is that no one grows faster than a newborn, no one.

Lots of families marvel at their sixth grader exploding with growth or their young teen teen suddenly seeming so tall in high school. But that famous growth spurt typically sees kids growing 2-6 inches a year.  

The newborn leaves that drama in the dust. During the first 4 months of life, babies can easily achieve rates of growing about 24 inches (!) a year. No one actually grows 2 feet in the first year of life, but for some weeks, maybe even a month or two, many babies will actually grow at that rate. The same happens with weight, and newborns achieve weight gain rates of 20 to even 50 pounds a year, at least for the first few months of life.

This explosive rate of growing requires prodigious quantities of food. For a 150-pound adult to eat what a typical newborn does, they would need to eat about 40,000 calories a day! This is why newborns need to eat every 2-4 hours – day or night, for months.

The inability to craft mature sleep cycles resolves itself by 4 months of age. After 4 months, a baby’s mind crafts fully matured sleep cycling, entering Stages 1 through 4 of sleep, rising to Stage 2, entering the dream world of REM sleep, and then, choosing to do the cycle all over again or wake up. 

Also around 4 months of age, the meteoric rate of growth slows dramatically. Babies go from growing as much as 24 inches a year to growing about 2 inches a year, and from gaining as much as 50 pounds a year to about 5 pounds a year – which makes for a pretty sharp decline.

The catch in all this is that no newborn ever tells their parents, after 4 months of the extremely urgent need to eat every 2-4 hours, that that need has come to an end and they can go 8-12 hours with no meal and no waking up. Babies continue to wake up. They like seeing Mom or Dad. So, it has to be up to Mom and Dad to figure out something is different and guide their infant to sleep all night.

Since newborns cannot sleep through the night, it makes no sense to ask them to. However, after 4 months of age, most babies are ready to sleep for longer stretches. The change from getting up many times a night to sleeping through the night is all about managing expectations.

Since birth, your baby has needed to wake up and feed several times a night. This means they have developed an expectation that when they wake up, Mom or Dad will respond by feeding them. Therefore, the shift to sleeping all night comes when a child awakens in the middle of the night and expects that when they call their parents, no one appears. When that is what always happens, they will expect that no one will appear, and will stop calling for you and learn to settle back to sleep.

Of course, when you change people’s expectations, they often get disappointed. If you decide to help your child find a path to new nighttime expectations and no longer respond when they call for you in the middle of the night, they will likely get angry, especially the first night. Fortunately, for nearly all infants 4 months of age and older, it only takes 2-4 nights to change that expectation.

Those several nights of distress can make a parent wonder: is my child OK? But giving your child the chance to adapt and to solve new challenges is actually a very powerful gift of trust that lets them grow and learn.

The very good news here is that unless other symptoms are present, there are almost no situations where waking up in the middle of the night by itself suggests a serious health problem is present. Does it indicate there is a potential conflict present? For sure.

After all, the reality of these situations is that the child wants one thing (to see you in the middle of the night) and the parent wants another (to get a full night’s sleep without interruption). That is by definition a conflict. From a medical point of view, conflicts over sleep are unpleasant but not worrisome.

A worrisome sign would be if a child cannot sleep due to an illness. That would be apparent if they had other symptoms like fever, pain, trouble breathing and such. And if ill, the level of worry of course varies by the severity of the symptoms: is the pain severe, are they struggling to breathe air in and out of the chest, is their neck able to move freely or is it stiff?

But we almost never hear of symptoms of illness for the typical story of a conflict, where the only issue is that the child wants Mom and Dad to wake up in the middle of the night after 4 months of age, and the parents want everyone to sleep through the night.

1. Sleep troubles are the #1 reason parents of young children seek help with parenting, and these instances are a negotiation in which the child would like to have the parent(s) wake up to be with them at night, and the parents would rather sleep through the night without interruption.
2. This conflict in desires is set up by the fact that everyone is born needing to be fed many times a night and unable to create night-long sleep sequences.
3. By 4 months of age, all healthy children slow their growth dramatically and develop their mind’s sleep patterns fully enough that they are able to sleep through the night.
4. If a family wants to sleep the night through, the path is actually very straightforward: help your older infant or child change their expectations away from expecting you will appear when called for and toward expecting you will not. Once you decide to change this expectation, the transition typically only takes 2-4 nights.
5. When considering when to worry about your child not sleeping through the night, the key indicators all have to do with symptoms of illness present, like fever, pain, and such. For a healthy child who has no symptoms of any illness, waking up in the middle of the night to see you is not an experience that raises any medical concern.