Has your baby started waking again? Or maybe she has never slept through the night. Whatever your baby's track record, the majority of babies have disturbed sleep at around 5 months of age.

If you have had a good sleeper, try hard to stick to your routine. It's likely it was those good sleep practices that taught your baby to sleep well when she was a smaller baby.

Avoid re-introducing night feeds (apart from the dreamfeed, see below), or feeding her to sleep, as this will likely lead to further night waking not less! Try to identify what has caused the change from our list below, and take action.

Teething is often blamed for babies starting to wake again...but this is generally not the real cause!

It's also quite possible that she has not yet learned to self settle, and the change to her sleep cycles means she is now waking fully in the night rather than drifting back to sleep. If you are rocking or feeding her to sleep, this will be causing her waking and needs to be addressed first. See Sleep associations & self settling.

If your baby has not been sleeping through the night, now is a good time to take action to teach her to self-settle. The longer you leave it, the bigger the battle, as habits are more well-formed. And as babies get older, new challenges arise, such as your baby being able to stand up in the cot.

Before tackling the list below, ensure you have gone back to basics, such as trying swaddling and ensuring you are using the Feed, Play, Sleep routine during the day.

It may help to remember that all babies over 5 months of age wake 4-6 times during the night, as they come to the end of each sleep cycle. This is normal, and also occurs with older children and adults. It's the falling back to sleep that can be the problem, particularly when the baby needs Mum or Dad to help them return to sleep. And crying out for Mum and Dad usually results in a baby who is fully awake, and harder to resettle.

So what may be causing your baby to not resettle when they wake in the night?

Missing sleep association:

This is the most common reason that babies can not get back to sleep without help during the night. Babies with a sleep association struggle to self settle, so they don't know how to 'sleep through the night'. This is particularly true after the sleep cycle changes that happen at 5 months.

• What does your baby need to fall asleep?
• And is this missing when she stirs in the night? For example, if you always feed your baby to sleep at bedtime, she has now learned that she needs this to fall asleep. So she cries when she wakes up and can't get back to sleep, as the feeding is missing. If your response is to get up and feed her to sleep every time she wakes up, your response is causing the night-waking to continue as it reinforces your baby's belief that she can't get back to sleep without you.

Make sure your baby can fall asleep at bedtime without needing you present, either feeding or rocking to sleep, continually putting a dummy back in, patting her or cuddling her to sleep.

For more information, read:

• Sleep association & Self Settling
• Teaching your baby to self settle
• Using & weaning dummies

Teething:

Teething is often given as the reason for night waking in babies of this age. It may cause the initial waking, but teething is generally not likely to be serious enough to cause waking and crying on an ongoing basis. Many babies and toddlers sleep through the night even when cutting painful molars.

If pain from teething is serious, your baby is likely to be very unhappy during the day as well, not just at night.

If you can see the tooth actually cutting through the gum, then your baby may need some pain relief for that night or two....and this is not the time to tackle sleep training!

If you believe your baby is waking from teething pain, please consult your GP, discuss suitable pain relief with your chemist or call Plunketline.

However, almost always it your reaction to the waking (eg getting baby up and feeding her) that causes continued waking and inability self settle. Remember that new habits can form in just a few days, so avoid falling back into night feeding and ensure your baby knows how to self settle.

Hunger:

Like teething, hunger is often given as the explanation for a baby who starts waking again during the night.

If she is 'rooting' (turning her head to the breast) when you pick her up, this may be the case. However before you go back to regular feeds during the night, look for ways during the day to prevent her from being hungry during the night.

Waking at about 5am is often due to hunger with older babies, especially when they can self settle and sleep through the night. We highly recommend doing a 'dreamfeed' (feed baby while she is asleep) at 10pm, so she can last all night without needing another feed.

If you think your baby is hungry:

• Re-introduce a 'dream-feed' - the feed you do at around 10pm while your baby is still asleep.
• Talk to your Plunket nurse about starting solids.
• If you are breastfeeding, a good option can be to express a bottle of milk after the first feed in the morning and offer after breastfeeding at bedtime.
• Review your routine, as the timing of milk feeds and solids can have a significant effect on both day and night-time sleeping. Check out 'Save Our Sleep' for excellent information on Feeding & Sleeping routines.
• Ensure you are eating well, not rushing around too much and resting when you can. The volume of late afternoon and early evening breastfeeds can be effected by tired, hungry mums!

Is it REALLY hunger????

Just because your baby or toddler happily accepts a feed in the night, that doesn't mean it's hunger that woke them in the first place. And it certainly doesn't mean your baby NEEDS that feed!

If you woke up and couldn't resettle, and someone offered you your favourite comforter, would you take it??? Of course you would, and so will your baby accept a breastfeed or bottle if they are upset, regardless of what caused them to wake or struggle to resettle.

Feeding a baby when they don't need it can lead to a sleep association ...ie a baby learns over time that they can only fall back to sleep by being fed.

Once your baby is over 4 months, you can try other settling techniques to see if your baby can go back to sleep without a feed. If your baby will resettle with a cuddle, patting, dummy or being given the opportunity to self settle....then it's likely that hunger is not the REAL issue!

Of course newborns need feeding during the night and will wake every 3-4 hours as their tummies are so little - remember the info in this article relates to babies over 4 months.

Waking from Cold:

Babies often wake from the cold, particularly once they are active enough to kick off blankets. The temperature between 3-5 am is significantly cooler than when you put your baby to bed.

If your baby is waking around 3-5am and can self settle at bedtime, then cold is highly likely to be the reason. Plus it is a very simple problem to resolve, so you can then see if there is any other cause for waking in the night.

We recommend you use a quality baby sleeping bag, such as a grobag or woolbabe sleeping bag. This means you don't need blankets (which can be kicked off) and ensures your baby stays a comfortable temperature all night. Click here for more information on baby sleeping bags.

Using merino nightwear isalso a good idea, as this helps babies regulate their temperature whether it is warm or cool.

Movement in the cot

This is also a very common reason for babies to not resettle in the night, including babies who were previously sleeping through the night.

Babies often 'scoot' up the cot and bang their head, or end up with arms or legs out the cot. As babies get older, they are also likely to stand in their cot and find it hard to lie them self back down.

This problem can be easily solved with either a Safe T Sleep Sleepwrap or a Baby OK Babe Sleeper. Either solution will fix moving around in the cot and significantly increase the likelihood your baby will sleep through the night.

We think combining a Safe T Sleep with a warm sleeping bag is the perfect solution for babies of this age - they are warm and stay in a safe sleeping position all night.

The Safe T Sleep is also a really positive sleep association - the process of being wrapped in the sleepwrap tells your baby it is time to go to sleep, and you can easily take the sleepwrap with you when you travel.

Different sleeping environment to where she fell asleep:

If your baby wakes in the night and finds they are in a different place or environment to where they went to sleep, they will be confused and likely to be unable to get back to sleep.....Think about if you stirred from a deep sleep and found your pillow was missing. It would be hard to re-settle!!

Ensure you put your baby to sleep where she will sleep all night, with the same conditions she will experience if she wakes, such as light, noise, warmth etc.

This also means not letting a baby fall asleep on you and putting her into bed asleep. A younger baby may transfer to the cot OK and sleep through, but once a baby is over 5 months this will cause difficulty with night-waking and failure to resettle. See The No Cry Sleep Solution for a gentle technique for weaning off rocking to sleep.

Dummies

Using a dummy can be a very strong sleep association for a baby, as they associate sucking with falling off to sleep.

As babies get older, they may start to need their dummy to resettle at each of the 4-6 times during the night when they wake......iIt's not the dummy causing the waking, your baby will wake anyway. The problem is that your baby likely doesn't know they can resettle without the dummy in their mouth.

If you find you are continually getting up in the night to replace the dummy, your options are:

• you may want to think about weaning baby from having a dummy - The most gentle technique we have found for weaning off a dummy is in 'The No Cry Sleep Solution'.
• teach your baby to put it back in themself (can be learned from about 5-6 months of age) - then the dummy becomes a self-settling tool for your baby.
• or you will continue needing to get up!!

Basically if you continue to get up and put the dummy back in for your baby, she will continue to need you to do this for her.

It's a very personal decision whether to use a dummy with your baby, and you need to decide for yourself what do do from here. Click here for our info on dummies.

Continued night feeds:

If your baby is still being fed in the night after six months, this may be contributing to or causing the night waking. She may now have a learned hunger, rather than actually needing to be fed like a newborn baby.

• Also if your baby is being fed several times in the night, this may be leading to wet nappies and further waking as a result. There is good information on this cutting out/back on night feeding in 'The No Cry Sleep Solution'.
• See Save Our Sleep for an age appropriate routine to ensure your baby is getting sufficient feeding during the day.
• If your baby is getting a lot of calories from nigh milk feeds, this can impact on the amount a baby will eat and drink during the day.

We also recommend you don't use feeding to get your baby to sleep after she is a couple of months old, as this will result in a baby who can not self settle and wakes frequently in the night. Read 'Pros & Cons of feeding to sleep' for more info.

Baby has never learned to settle herself:

If you always put your baby to sleep by feeding or rocking, she has not learned that she can settle herself to sleep.

The same applies if you feed or rock your baby until they are drowsy, and put your baby into bed straight after...so while her eyes may be open for a few seconds after the feed/rocking, she relies on that to get to sleep.

Start by trying to put her down for day-time naps sleepy but awake, then move to doing this at night. You can refer to 'The No Cry Sleep Solution', the Sleepeasy Solution or 'our article on Teaching your Baby to Self Settle for ideas.

It is worth experimenting to see what happens when you do let baby try to settle herself. It may only take a few minutes of crying or grizzling during the night before she does settle herself. We get constant feedback from parents that they are surprised how quickly their baby learns to self settle when given the opportunity. And the longer you don't teach your baby this essential skill, the harder it will be when you finally do.

Medical conditions:

There are a number of medical conditions that make sleeping difficult for babies and toddlers, and will make teaching your baby to sleep through the night difficult.

Two examples are ear infections and reflux (including silent reflux without spilling). If you have covered all other options with your baby, they know how to self settle and they are still waking crying or screaming, please urgently discuss this with your GP. If your baby has either of these painful conditions, adding controlled crying or cry it out to the mix would be very unfair on your baby (and you).

Another issue some customers have mentioned to us is allergies - severe eczema can really make resettling difficult. Plus some food allergies, such as a bad dairy allergy, can cause a lot of difficulty with sleeping.

For more information on reflux, please visit the excellent website Crying Over Spilt Milk. For all other medical conditions, please consult with your medical professional. You may find our gentle sleep training information in the article 'Gently wean your baby off rocking' is relevant with babies who are unwell but still need improved sleep.

Worms:

Another condition that can cause a baby to start waking again is worms. If your baby has been sleeping through and suddenly starts waking and is really hard to settle, investigate this as a cause!

Go in while your baby is asleep, leaving the light off. Use a torch to check if you can see any tiny white worms around your baby's anus. Worms are quickly and easily treated with over the counter medication such as Vermox.

Sickness:

There are always lots of colds and tummy bugs going around babies and toddlers. These can cause babies to wake, especially with dirty nappies!

We recommend you take your baby to the doctor and ensure it's nothing serious. And as soon as your baby is recovered, get back to your normal night time routine so new habits don't stick!

If your baby suffers from more serious or ongoing health problems, good sleep is even more important, as it will help her heal more quickly. And you need a decent sleep to cope with the stress and workload of a sick child. Consult with your doctor before starting a sleep program. The No Cry Sleep Solution is a good option if you are not comfortable leaving your baby crying to self settle.

Summary:

So there are a number of reasons why your baby is waking and not settling herself back to sleep. We recommend you think through which reasons are relevant to you and your baby, and make a plan of attack from there.

You can download our Sleep Plan here.

You can cross your fingers and hope things improve. But 50% of baby sleep problems are still a problem at preschool age..... so why not tackle your sleep problem now before the habits get further established!

Read more information for babies 4-12 months

Buy the Sleepeasy Solution to teach your baby to sleep through

Read about sleeping bags