[Emma H]

Hi Santiago,

I’m so sorry for my delayed response! I somehow missed your post.

Before I provide some suggestions, I’ve got a few questions. You’ve given a lot of helpful information already, but there are a few more details I’d love to understand so I can give you the best advice.

1. Her general mood during the day. You mentioned she escalates to crying quite quickly. After a feed during the day, is she generally quite happy and it’s only when she gets tired that she gets a bit upset? Or do you find she’s always upset and just appears uncomfortable or generally unhappy?
2. The daytime routine. Your wife is feeding her every 1.5 hours during the day, so I’m guessing you haven’t quite been able to implement the wake, feed, play, sleep routine yet. Is it more like wake, feed, play, feed, sleep?
3. Self-soothing with her hands. Since she’s been bringing her hands to her mouth and you’ve stopped swaddling, have you noticed her starting to suck on her fingers to self-soothe?
4. Bedtime and wake time preferences. Her wake-up time is between 7:30 and 8:00, with bedtime around 9:00 to 10:00. Would you like bedtime to be a little earlier? And if so, would you be happy to move her wake-up time to an earlier slot as well?
5. The 40-minute waking. It sounds like she’s going to sleep around 9:00 and waking up 40 minutes later. Sometimes disturbances can cause these early-night wakings. Has anything happened around the 40-minute mark, either before or just after, that might have stirred her? For example, someone entering the room, or a loud noise from a room next door?
6. Her daytime naps. How long is she generally staying awake between naps? And is that first nap starting to happen at a consistent time?
7. How she’s actually falling asleep. You mentioned the settling pyramid has been helpful, which is great! But I wanted to clarify exactly how you’re getting her to sleep at the moment. Have you been able to implement the pyramid, or are you currently rocking her to sleep in your arms or is your wife feeding her to sleep and then laying her down?
8. Sleep Environment. Can you please describe her sleep environment? So for example, is the bedroom cool, dark (dark enough that you wouldn’t be able to read a book), and quiet? Is she sharing a room with you and your wife overnight sleeping in a crib, or is she co-sleeping or in her own room? During the day, is she napping in a crib, on you, or in the baby carrier?

About the pacifier

Around 5 to 6 months of age, the way to improve naps (by lengthening them) and improve overnight sleep is to develop your little one’s ability to fall asleep independently.

Sometimes the pacifier works really well because you can pop it in, they fall asleep, and they’re not bothered when it falls out. But for some babies, when the pacifier falls out during sleep, they wake up, which results in shorter naps and more frequent wakings overnight. It sounds like that might be what’s happening with your little one.

There are a few options we can look at for reducing her reliance on the pacifier to fall asleep. But first, I’d love to hear your answers to the questions above so I can get a clearer picture of what’s going on, particularly around how she’s being settled to sleep, and how we can tweak things if needed to help build that self-settling skill.

Looking forward to hearing back from you!

Emma

[Emma H]

HI Cherry,

Wow, 12 weeks already! Time really does fly!

Your approach to settling her for naps sounds really great. Doing your nap routine, putting her in the crib, placing your hand on her chest for a count of ten, then taking it away and moving away from her and letting her drift off by herself – is a bit like your own modified settling pyramid, and it’s definitely going in the right direction. Keep doing that!

The one thing to be wary of is if she’s really drowsy when you put her down, meaning she’s actually falling asleep in your arms before she even gets to the crib. But it doesn’t sound like that’s what’s happening. It sounds like she’s cooing and sucking her hands when you first lay her down, and then falling asleep, which tells me she’s fully awake when you put her down.

A consistent daytime schedule is fine at this age, if that works well for both of you.

Bedtime and overnight sleep

Moving bedtime forward was definitely the right move! It’s fantastic that she’s now doing a solid four to six hour stretch at the start of the night. What tends to happen is they have that long stretch early in the night and then wake more regularly later on, which is completely normal.

I wouldn’t recommend a dream feed at this stage, because we really want to encourage and protect that first long stretch of sleep she’s already doing so well.

It also makes sense that she’s waking a little earlier now. Previously, with a 10:30 pm bedtime, she was sleeping until around 8:00 am — that’s roughly 9.5 to 10 hours overnight. Now that bedtime has shifted earlier by about an hour, her wake-up time has naturally shifted earlier too. Unfortunately, for most babies, their natural wake-up time tends to fall between 6:00 and 7:00 am, they’re just early risers.

Since you’ve only just started shifting her bedtime forward, I’d give it a little more time before drawing any firm conclusions. If she consistently wakes at 6:00 am, that may simply be her preferred wake-up time. In that case, something like an 8:00 pm bedtime and a 6:00 am wake-up would give her around 10 hours overnight, which fits her pattern well.

Is she getting enough sleep overall?

The best gauge is how she seems when she’s awake. If she’s happy and content during the day and doing that nice long stretch overnight – only waking once for a feed and then sleeping through to wake-up time – that tells us she’s getting enough sleep for her needs right now. If you find she’s consistently irritable during the day, or staying awake for long stretches during the night, it might mean she needs a little more sleep, and we can look at options for that if needed.

I hope that helps!
Emma

[Emma H]

Hi Kateryna,

Before I give you specific advice on transitioning away from rocking, I’d love to get a clearer picture of where things are at. So when you have time can you please answer the questions below?

His routine

• Does he have a consistent wake-up time each morning (within about a 30-minute window)? If so, what time does he usually wake?
• Have you been able to implement the wake, play, sleep routine during the day?
• How many naps is he having, and how long are they roughly?
• How long is he typically staying awake between sleeps?

His nap settling

• Have you been able to put a nap routine in place? If so, can you walk me through what that looks like?
• When it comes to actually settling him, are you completing the nap routine and then holding him upright in your arms while rocking him side to side, or are you sitting on the exercise ball and bouncing up and down? Are you doing anything else at the same time, like singing?

His sleep environment

• Is he swaddled or in a sleeping bag?
• Is his room cool, dark, and quiet?
• Is he using a pacifier?

Bedtime

• Have you been able to start a bedtime routine? If so, what does it look like, and how are you settling him to sleep at night?

Sorry for all the questions! Once I know the answers, I’ll be able to give you much more targeted advice on how to gently work towards more independent settling!

Emma

[Emma H]

Hi Benjamin,

You’re right, the advice out there can be confusing!

The second piece of advice is the one that aligns with current safety guidance. The goal is to keep the sound level at your baby’s ears within a safe range, not just to limit what the machine is set to. So it’s the volume where your baby is sleeping that matters most.

The AAP recommends keeping it at or below 50 dB at the baby’s ear, while the CDC puts the limit at 60 dBA. In practice, aiming for somewhere in that 50–60 dB range is a safe target.

To check, simply open the NIOSH Sound Level Meter app on your phone, place it in your baby’s sleep space with the white noise running, and take a reading. If it’s above that range, turn the machine down until it falls within it.

As for placement, further away is always better, but honestly, don’t stress too much about the exact distance. The most important thing is that the reading at your baby’s ear stays within that safe range. If it does, you’re good! That said, positioning the machine between the noise source and your baby’s crib is a great approach when you can manage it.

Hope that clears things up!
Emma

[Emma H]

Hi Jessica,

It sounds like your baby’s sleep space is great in terms of being conducive to sleep, and it’s fantastic that you’ve been able to adopt a consistent wake-up time and bedtime.

Before I can give you some strategies to lengthen your little one’s naps, I have a few questions. When you have some time, can you please answer the questions below?

1. Have your little one’s naps always been 30 to 45 minutes in length, or were they around 1.5 to 2 hours, and is this a recent change? If it is a recent change, do you think she’s getting sick, or has she been sick recently?
2. Could you outline the timing of her naps, how many naps she’s currently having in the day, and the length of those naps?
3. Can you step me through what the nap and bedtime routine looks like?
4. Have you been able to follow the pattern of wake, feed, play, sleep during the day?
5. Does she use a pacifier at all?
6. You mentioned she can self-soothe, can you tell me what that looks like? Eg. After you’ve done the nap routine, do you put her in the crib and walk away, or do you put her in the crib, pop a pacifier in, and walk away or do you stay in the room.
7. Does she self soothe for bedtime and naps?
8. Is she waking during the night? If so, can you let me know what time she is waking and what you do during those wakes to get her back to sleep?
9. Is anything happening in the room/house around 4:30/5am? For example, is the sun rising at this time, is anyone getting up for work or going to the toilet etc?

Sorry for all the questions,

Emma

• This reply was modified 1 month, 1 week ago by  Emma H.

[Emma H]

Hi Patrick!

It sounds like your little one has learned to fall asleep using movement, and is then relying on that same movement to link her sleep cycles.

Here’s what’s happening:

During the day, when she stirs between sleep cycles (around that 30-minute mark), you’re naturally rocking, shushing, or moving to help her resettle which links her into the next cycle.

At night, it’s a slightly different picture. Nighttime sleep cycles are longer than daytime ones, around 90 minutes compared to 30–45 minutes during the day. So when she wakes between those cycles, she needs you to recreate the movement (or pick her up) to fall back to sleep, which is why nights are more broken.

The key to longer nights is helping her learn to fall asleep without movement, and ideally fall asleep in her crib from the start of each sleep. Once she can do that, she’ll be able to resettle herself between those sleep cycles without needing you.

It’s great that you’ve already stopped the bouncer, that’s a really positive first step!

To help me point you in the right direction, could you let me know:

• What you’ve been able to try from the course so far
• What her nap routine looks like, step by step
• What her bedtime routine looks like, step by step
• How you’re currently settling her to sleep

Once I can see the full picture, we can work out exactly what to tweak!

Emma

[Emma H]

Hi Pav,

Poor Rohan! It sounds like it’s just one thing after another at the moment. Hopefully those molars come through soon and he’s a bit more comfortable.

Just to clarify what I mean when I say “12 for a nap” with Rohan, I’d actually lay him down a little before 12 so he’s asleep by 12.

For a 22-month-old, a typical day usually looks something like this:

• Wake: anywhere between 6 and 7am
• Nap down: around 12
• Wake from nap: anywhere from 1.30 to 2.30 some kids can even sleep until 3pm (these kids tend to have a later bedtime)
• Bedtime: around 6:30/7pm

So if they wake at 7 and are asleep for their nap by 12, that’s about a 5 hour first awake window. And if they wake from their nap around 2.30 and go to bed at 7/7.30, that’s roughly a 4.5–5 hour second awake window.

Hope that helps clarify things!

Emma

[Emma H]

No worries.

Let me know how you go! And we can tweak things as needed.

[Emma H]

Hi Santiago,

Thank you for sharing all those details! Here are my thoughts and suggestions:

Overnight sleep

The pattern you’ve described – a longer 3-4 hour stretch of sleep, followed by shorter stretches as the night goes on – is very typical for this age. Over time, that first stretch of sleep at the start of the night will gradually lengthen, which means she’ll wake less frequently overall. Since she’s already falling asleep without the pacifier at bedtime, I expect this will happen naturally for her with time.

Handling the 40-minute fussy wake

When she gets fussy after being awake only 40 minutes and changing the activity doesn’t help, that’s usually a tired signal. Rather than offering another feed, I’d suggest:

1. Pop the pacifier in and then change up the activity.
2. If she keeps fussing, move straight into your nap routine.

Why I’d hold off on the top-up feed

When babies feed at this point, they often fall asleep on the breast without you realising – they keep sucking but stop swallowing regularly. Even a very short “feed-sleep” reduces her sleep pressure, which is the main driver of falling asleep at this age. With less sleep pressure, she’ll fight the nap harder and the settling pyramid becomes much tougher to do.

Given she’s gaining weight well and has plenty of wet nappies, her short 7-8 minute feeds are likely enough – some babies are very efficient feeders. I’d encourage you to try a wake, feed, play, sleep rhythm during the day and see how she goes.

A note on hand-sucking

Around this age, babies start bringing their hands to midline and sucking on them – a lovely developmental milestone (and one I get excited about as an OT!). This can mean the pacifier falls out more often. You may need to reinsert it, or you might find she prefers her hands, in which case you can start fading the pacifier out.

The morning nap routine (for your happy to try)

1. Feed her at the usual wake time.
2. When she starts getting drowsy or stops actively feeding, change her nappy to wake her back up.
3. Offer her a top up feed her so she fills up properly.
4. Once she finishes the feed, it’s play time.
5. When she starts to get fussy (around the 40 minute mark), pop in the pacifier and change the activity.
6. If she keeps protesting, move to the nap routine.

Nap routine with gradual movement reduction

Since she’s been exclusively napping in the baby carrier until two weeks ago, she’s used to movement to fall asleep. We want to gently reduce that reliance:

1. Walk around the house briefly with the pacifier in to help her calm.
2. Once calm, go into the bedroom. Skip the nappy change unless she’s done a poo – it’s too stimulating and can wake her up.
3. Close the blinds, turn on white noise.
4. Sing a song while rocking her in your arms.
5. Once the song ends, gradually reduce the input in this order:
   • Slow the rocking while patting her bottom and shushing
   • Stop rocking completely, continue patting and shushing
   • Stop patting, continue shushing
6. Before she falls asleep (not drowsy – just calm), lay her in the crib.

Starting the settling pyramid from the top

If she gets unsettled as soon as you lay her down, start at the top of the pyramid rather than the bottom. Place one hand on the side of her chest and the other on her hip, gently rocking and shushing. As she calms:

1. Stop rocking, continue shushing.
2. Move your hands away, keep shushing in her line of sight.
3. Gradually move out of her line of sight so she falls asleep independently.

If the pyramid feels like too big a jump

Instead of laying her in the crib, just hold her in your arms in complete silence – no patting, shushing, or movement – and let her fall asleep. This helps her practice falling asleep without input from you, which makes the transition to the pyramid much easier later on.

A realistic expectation

You can try this for all naps, but you’ll likely have most success with the first nap of the day and bedtime. Afternoon naps tend to be the trickiest. At bedtime, it’s not unusual for babies this age to fall asleep on the breast – if that’s what’s happening for your wife, that’s completely fine.

Reducing pacifier reliance
If you do want to reduce your little one’s reliance on the pacifier something you can do is just before she falls asleep – whether in your arms or using the pyramid – slip your little finger into the corner of her mouth to break the seal and remove the pacifier. Some babies will drift off without it; others will wake and need the process restarted. If that happens with your little one, I’d focus first on getting her comfortable sleeping in the crib with the pacifier, and we can work on fading it out later.

Does this sound okay?

Emma

[Emma H]

Hi Paven,

Your plan sounds good. From what you have said, it does sound like with the new wake window length at the end of the day, he seems to be generally happier and settling to sleep slightly quicker.
I would try and keep this pattern for a week and then review it, as it can take them a little while to adjust.

Keen to hear how it goes.

Emma

[Emma H]

Hi Pav!

It’s great to hear from you again.

It sounds like Roh had a few rough weeks with illness, then the vaccine, and then that developmental leap on top.

Has the change in behaviour continued, or if it has started to settle down? Often, when illness and vaccines happen, their sleep can disrupt for a little while, but it tends to settle back down within a few days to a week.

If it hasn’t settled down, after looking through the record that you emailed me, I noticed these things:

– Rohan was taking a long time to fall asleep on the 26th, 28th, and 29th. What I’m wondering is whether this was a relatively new behaviour that started at this point in time? If it was, your notes indicate that Rohan started coughing on those days, which leans more toward the fact that he might have been getting sick or slightly unwell. That might have been the reason Roh was finding it challenging to fall asleep at bedtime. Do you think this might have been the case?

– It looks like it was on the 30th that you started to extend the final wake window. His mood on the 30th and the 31st was great, which makes sense. The amount of time it took him to fall asleep reduced on those days. Now, the tricky thing here is that if it is over tiredness, generally we don’t see it for a few days. But Roh got his vaccine on the first, and vaccines can disrupt a little one’s sleep because of some minimal pain they might have at the injection site and leaving them feeling a bit off. So it’s hard to determine if the pattern is because he is overtired.

– The other thing I noticed is that on the fourth, fifth, and sixth, you woke him at 7:00. Generally, when kids are getting enough sleep, they wake up by themselves. So, that could indicate he’s not quite getting the amount of sleep that he needs.

I’m wondering if you’d be willing to do a few things:

1. Have his daytime nap consistently happen around 12:00.
2. Consistently wake him at 2:00.
3. Keep the final wake window at 5.5 hours, so he’s in bed (where you’re laying him down in his bed) at 7:30.
4. Track the amount of time it takes for him to fall asleep.

By tightening up that schedule, it will ensure that bedtime becomes more consistent for him, which is ideally what we want. Generally, kids do better when bedtime is consistent rather than fluctuating all the time.

Would you be happy to give this a go for a week?

Emma

[Emma H]

Hi Lizzie,

Wow, 3.5 months – she’s growing up so fast!

From what you’ve described, it does sound like the dummy might be causing those more frequent night wakings. So I do think it might be time to let it go, and it’s absolutely fine to start now rather than waiting until four months. That said, if you’d prefer to wait, that’s okay too. Just know she’ll likely continue waking frequently overnight until you make the change.

How to fade out the dummy

You have a few options:

Option 1 — Cold turkey Remove it completely.

Option 2 — Use it in the routine, remove before the cot Do your usual pre-sleep routine. When you’re singing your lullaby with her in your arms, pop the dummy out at that point and finish the song without it. Then lay her down in the cot and use the settling pyramid to help her fall asleep without it.

Option 3 — Keep it in until just before she falls asleep Use the dummy all the way through the routine and lay her down in the crib with it still in. Use the settling pyramid to help her fall asleep and then gently slide your finger between the dummy and the corner of her lip to pop the dummy out just before she falls asleep. Some babies will drift off after that, others will wake up fully. If she wakes up, Option 2 is likely a better fit for her.

What about naps on the go?

It really depends on how often those on-the-go naps happen. If most of her naps are out and about, I’d be cautious about using the dummy for all of them, as she needs some opportunities to practise falling asleep without it. But if it’s just one nap a day or an occasional car trip, that’s completely fine. Car rides are one of those situations where a little extra help is totally reasonable!

Also, something else to note with fading out the dummy: if it feels like it’s too much to do that for all naps, what you can do is choose one of those options that I mentioned and do it for bedtime and that first nap of the day. Those are generally the easier ones to get babies to fall asleep with. This can give her an opportunity to learn to fall asleep with their settling pyramid, and once she’s doing that, you can then transition it through to all the naps.

I hope that helps clarify things

Emma

[Emma H]

No worries at all.

[Emma H]

Hi Patrick,

Thanks for sharing all of that!

So when little ones get sick, it can definitely set their sleep back a little and the reason for that is pretty straightforward. When they’re unwell, uncomfortable, or in pain, we naturally do more to help soothe them. And once they get used to that extra input to help them fall asleep, they start to expect it, even after they’re feeling better.

Now, you also mentioned she might be teething. One thing that can help you figure out whether pain is causing the wakes is to look at the timing of them. If she’s waking at random times – not every 90 minutes or two hours, just unpredictably – that’s often a sign that pain is the culprit rather than a sleep association. If that sounds like what’s happening, it’s worth having a chat with your doctor about pain relief options to help her through it.

I do have a few more questions so I can get a clearer picture of her routine before I give you more specific guidance:

• Day routine: Are you generally following a wake-feed-play-sleep routine during the day? You mentioned your wife sometimes settles her with a feed – is that mainly for the overnight wakes, or is she also feeding her to sleep for naps and at bedtime?
• Nap settling: When she’s on the bouncy ball, are you singing a lullaby, or is it done in silence? And when you move to rocking her in your arms, are you rocking until her eyes are closed, or just for the length of a song before putting her down awake? Is she already asleep when you put her down?
• Baby carrier: Have you moved away from using the carrier altogether? Or do you rock her in your arms and then transfer her into the carrier to fall asleep for naps? Or does she start in the cot, and then when she wakes after 30 minutes you put her in the carrier to extend the nap?
• Bedtime Story: You mentioned that you read your little one a book in the living room. When you do this, have you turned the lights down in the living room and maybe just have a lamp on?
• Bedtime settling on your wife’s chest: When your wife lays her down on her chest – is she sitting down in a chair with your little one lying on her, shushing and stroking her back or tummy? Or is she standing and moving while doing that?
• Bedtime feed: I’m guessing there’s a feed somewhere in the bedtime routine – is it before the washcloth and warm water, or does it come a bit later? If it’s later, can you let me know where it fits in?
• Pacifier: You mentioned she used a pacifier occasionally. Do you use it as part of the bedtime and nap routine, or just for the overnight wakes?

Sorry for all the questions! I just want to make sure I’ve got a really clear picture of how things are looking before I give you my recommendations.

Emma

[Emma H]

Hi Tatsiana,

Given that your little one has recently started the medication and the side effect is gassiness and the wakings at night have only recently started, they could be due to the medication.

But the other thing it could be is that your little one is going through the 4-month sleep regression. It’s not really a regression; it’s more like a regression in that they go through four stages instead of two. When they wake between sleep cycles or are partially awake between sleep cycles, if they need your help to fall asleep, they are more likely to wake fully and then need you to recreate whatever it is they need to fall asleep.

Generally, if they’re waking due to pain, the wake-ups overnight happen at random times and are not really like clockwork. If it is due to the 4-month regression, the wakes tend to be really predictable and happen at really predictable times, almost as if you could set a stopwatch and you’ll know when they’ll wake up. That sounds like it might be the case with your little one.

Just to help you move through this stage, I’ve got a few questions. When you have time, can you please answer them so I’ll have a clearer idea of what’s going on with your little one and be able to provide more tailored suggestions?

1. You mentioned you’re moving her wake-up time earlier. Can you let me know what her current wake-up time is?
2. Are you keeping the morning wake up time within the same 30 minute window?
3. Also you mentioned you are shifting her wake up time and bedtime earlier, how often are you making the adjustments and how big are they? For example, are you shifting her wake up time and entire day schedule 15 minutes earlier every 3rd day?
4. How long is she tending to stay awake between naps?
5. Are you able to let me know how many naps she’s having during the day, the timing of those naps, and the length of those naps, if possible?
6. Can you walk me through what her nap routine looks like and how you get her to fall asleep?
7. Can you also tell me what her bedtime routine looks like?
8. Can you let me know what time bedtime currently is? You said you were trying to move it forward, but you haven’t had much success with that, so you can just let me know what time she’s actually falling asleep at bedtime?
9. Are you swaddling your little one?
10. Are you using a pacifier?
11. Have you been able to follow the wake-feed-play-sleep routine during the day?
12. You mentioned that her final nap of the day is between 6:00 and 6:30, but bedtime might be around 10:00. Is that the case, or is she having another nap somewhere during that wake window?

Sorry for all the questions.
Emma