To feed and change diaper or to soothe baby to go back to sleep?

by Ines
(Miami, FL)

Question: My baby is 19 weeks today. He is bottle fed breastmilk. He usually eats every 3-4 hours during the day and about 5 hours at night. At around 3 months my husband and I decided we wanted to sleep training and wanted to eliminate a night feeding to promote him to sleep 5-7 hours.

We would feed him last about midnight and again around 6:00 am. When he woke up at 2:00-3:00 am, I will give him his pacifier, bring him to my bed, or walk him to sleep. We tried this for about 4 days. Then he started having diarrhea due to an allergic reaction to milk protein (or so we think as per his pediatrician).

Since he had diarrhea we figured he needed to eat so he wouldn't get dehydrated. We reinstated the "night feeding." He had this diarrhea for almost a month, his pediatrician said it was ok as long as it wasn't bloody or had mucous.

He is now 19 weeks and about 4 days ago we discontinued the swaddling (we only swaddled him from the waist down) since he is now rolling over and I was scared he will suffocate with the swaddle. I am thinking now I should start the sleep training.

Should I change his diaper? feed him? or just soothe him to go back to sleep? He is going through a growth spur. Today he was extremely gassy (which he is not usually) and ate every 2 hours and some feedings 2-3 ounces every hour. I was just reading I should probably feed him enough but not fill him up.

I'm concerned if he doesn't get his usual 5 ounces (we have decreased it to 4 ounces sometimes), he will wake up earlier and he's been consistent with waking up every 4-5 hours at night. What should I do? I don't want him to get a rash if he's wet or dirty if I don't change his diaper. I would also like him to sleep through the night. I eagerly await for your advice.

Heidi's answer: Dear Ines,

The gentle sleep training you have in mind may work, if I understand correctly that you want to wean from one night feeding by just not offering it. However, while he is in a growth spurt, and on top of that unusually gassy, it is not the right moment.

Weaning from a feeding will only work if he is in optimal shape. So the first thing to do is to go along in his growth spurt. Feed him extra if necessary, on demand. Do be careful of course to avoid over-feeding or too frequent feeding (which can both cause the gas) or restless feeding on his part (which again can cause the gas). Indeed, the best is to feed extra, spread throughout the day, without filling up right before bedtime.

See the baby gas page for details on how to avoid and relief gas.

Give it at least a good week in which you address the growth spurt and relieve the gas as much as possible. Meanwhile carefully observe how much he drinks. There is a good chance you will find him evolving towards fewer, larger feedings.

Once all is settled again after the growth spurt, the gas relieved and the new feeding schedule set, you may notice that the night feeding automatically disappears.

If it doesn't, the easiest is to wean from it gradually. So instead of simply not feeding at that time, gradually reduce the intake at that awakening.

Dilute the formula a bit more each night (same amount of water for a bit less formula, and then a bit less formula each night). This way you gradually wean him from the hunger feeling at that moment. The awakening and feeding will become less and less important, until it disappears completely or you will find it easier to not feed at all anymore.

If you have reduced the feeding until almost nothing (water) and he still wakes up, use the gentle self soothing method to teach him to settle back by himself.

For more detailed weaning and sleeping-through techniques, see my dedicated guide.

To answer your diaper questions: choose a good quality, right-size diaper which you change him into right before going to bed. If it does not feel very heavy or smells when he awakes at night, you can skip the changing.

That helps to keep the awakening as short and boring for him as possible, crucial to help reduce it importance.

If the diaper is wet or dirty, you will of course need to change it (it may even be the reason he wakes). Try to do this in his room, with as little or preferably no extra light as possible, to keep him from waking more than necessary.

Good luck,
Kindly,
Heidi