Getting Baby to Sleep (4 to 6 Months)
Module 3: 4 to 6-Month Sleep, Feeding, and Soothing

4 - 6 Months Feeding, Sleep, and Safety

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3 - 6 Months Feeding, Sleep, and Safety

20 MINUTE READ

Published August 2024

AUTHOR

Melissa O’Neill, PhD PMH-C
Contributing Editor, Registered Nurse

Katie Sardone, PhD PMH-C
Head of Clinical, Licensed Psychologist & Perinatal Mental Health Specialist

Margaret Vadiee, PhD
Contributing Editor, Licensed Psychologist

How fast have the first few months gone by?  Does it seem like a blur or have you savored and notated each day to remember forever? Whatever your parenting style is, babies develop on their own timeline and the next few months are coming in hot!  If you’re ready to get into a good sleep and feeding routine, now is the time!

We could ALL use a bit more sleep…

You’ve made it through the first few months, phew!  There are plenty of adjustments (pivots) needed this first year and the 13-week mark is one of them.  Maybe you started early, and your baby is already on a great schedule and sleeping well. Or maybe you didn’t want to think about any of that, and you are ready to get started now.  Either way, this guide will help you implement, and adjust, what is needed for the next few months.

Breaking down feeding schedules

Months 3 to 4 (weeks 13 to 20)

Your baby is still likely eating every three hours during the day at this point but may have dropped night feeds if your baby is efficient enough to get in all their calories during the day.  If you are still feeding your baby in the middle of the night now is a good time to work towards dropping it. Continue to increase daytime ounces/calories so your baby no longer needs that extra feeding (because they’ll be getting their calories during the daytime).  Babies are very aware of their hunger cues and rarely overeat. They will not continue to eat in the middle of the night if they are satisfied with their daytime calorie intake.  So to offset your baby waking at night to eat, they need to eat all their calories during the day, so they are satisfied (just like an adult would).  A full tummy at night doesn’t keep your baby asleep, enough calories during the day does. Follow your baby’s lead on feeds in terms of how much they eat (Satter, 2024)! You will find some feeds are easier to get more in than others.

You may also need to increase baby’s nipple flow to get those extra daytime calories in as well. If you’re really struggling to drop the middle of the night feed, you want to make sure your baby is taking a full bottle during the last feed (sometimes called a dream feed)may reduce the likelihood of a middle of the night awakening.

   

Months 4+ (weeks 21+)

Many babies are ready to transition to a more consistent schedule, eating every 4 hours now during the day. They are even more efficient eaters and can consume what they need in less time.  If your baby is eating more than 5 ounces in a feeding, it is time to increase their nipple flow.  We want to speed up feeds at this point and try to limit distractions to get those daytime calories in and really solidify your baby’s schedule. Babies are curious and easily distracted and so you might have to get creative to keep them focused on the task at hand - eating! This can be fairly easy for the morning and bedtime feeding as you can feed them in their quiet room with the lights low.  During the day, try to find a quiet place to feed your baby to limit distractions. If you are nursing, try a nursing cover to keep your baby focused.

The American Academy of Pediatrics (AAP) recommends starting solids after the 4-month mark, and for some babies after 6 months.  Talk with your pediatrician to decide when is right for your baby to venture into the world of solids. We cover solid food transitions in a separate guide so more to come on that! In general - you can tell babies are ready for solid food transitions when they: 

  • Show good head & neck control      

  • Express interest in what you are eating or drinking.  They may grab at your cup or watch you closely when you are eating.  

  • Mimic you - making the same facial expressions as when you eat or swallow

These are all great signs that your baby is getting ready to eat solids, but before you make the leap…chat with your pediatrician.   

Baby’s sleep location

Many babies are able to sleep 11+ hours at night at this age.  If your baby still needs some time, not to worry, it is never too late to work on great sleep! The AAP recommends room sharing (never bed sharing) for the first 6 months. If you are sharing a room with your baby, baby should always sleep in an infant safe device. 

Once you are ready to move your baby to their own room, baby should sleep in a crib, or another infant safe sleep surface, free of any bedding, bumpers, or toys. Continue to follow all of the Safe Sleep Practices outlined below (if this is new information, there is no time like the present to make sure your baby is in the safest environment possible)! The mattress should have a tight-fitting sheet and baby should be placed in the crib on their back with no other objects around them (no blankets, toys, bumpers, quilts, etc).  The room should be kept at 68-72 degrees and well ventilated to ensure sufficient airflow around baby. Black out shades are a big help in supporting your baby’s circadian rhythm and helping to keep that sleep schedule. We want the nursery to stay very dark at night and having the ability to limit light for daytime naps will help baby sleep longer!     .  


White noise is a very helpful soothing and sleep tool for babies.  Use constant white noise, rather than waves or rain, for all sleep in baby’s sleep environment.  This will help baby fall asleep and connect their sleep cycles, which are only 30-45 minutes long at this point.

Supporting strong, safe sleep habits

Teaching your baby to fall asleep independently (and putting themselves back to sleep independently) is not only helpful, but also recommended by the AAP.  There are several studies that show positive effects of “sleep training” babies including a NCBI study that shows a 50% improvement in sleep issues by 12 months when sleep training is introduced (Hiscock et al., 2007). However, sleep training is a broad spectrum ranging from the seldom used technique of letting a baby “cry it out” to the idea of asking parents to sleep on the floor next to their child’s crib. In reality neither of these extremes is typically the right answer. Rather, sleep training is more of an art than a science. We know that each parent’s sleep training journey will look unique. Ultimately as a parent you will know what works best for you and your baby. 

Triplemoon defines sleep training as a set of techniques that you use consistently and persistently to help your baby get to sleep and stay asleep. These techniques help your baby to recognize that sleep is coming and to look forward to sleep as a time of rest and relaxation (even babies need a break from their parents sometimes!). Sleep training takes time, but according to the research it will pay dividends! As your baby matures, your techniques may need to evolve. We’ll focus on the 4-6 month timeframe in this guide.

  • Following an appropriate feeding schedule consistently will help set baby up for success. Just like you enjoy breakfast, lunch and dinner - baby enjoys getting fed on a routine to help keep baby generally satisfied and blood sugars level.  It’s key that baby feels satisfied rather than “full” before going to sleep. Full tummies can take away from great sleep either due to baby depending on milk to fall asleep or becoming overly full and not being able to properly digest.

  • Babies seem to grow before your eyes, and each new milestone is fun and exciting.  Rolling is a big leap for this age, and once babies master their new trick, they have fun practicing day and night.  In periods of rapid development and when big leaps are pending, babies can get frustrated, and sleep can be even harder.  Lots of practice during the day is very beneficial if you know they are on the verge of mastering something new.  Aim for 10-15 min of tummy time 3-4x per day now.  Really you can’t overdue tummy time, it is good for so many reasons, like regulating the GI system, building muscles, and getting energy out (American Academy of Pediatrics, 2022).  Attention spans are short, so you may need to change it up for baby to get this exercise in.  

  • You can never talk to a baby too much. This includes leading up to sleep time! Setting expectations may involve a set of words you use each time you start preparing for bed. Babies are smart and understand language much earlier than we think. Using your words to set expectations is a great communication practice, including with baby! Something like “Daddy loves you very much. It’s time to rest now and we will get to snuggle more afterwards” is great. Whatever feels natural and genuine to you! 

  • This may look like a diaper change, followed by a sound machine turning on, a pacifier offered, a bath before bedtime, perhaps a few minutes of rocking to the sound of a lullaby, and/or reading a book together. This routine is a great bonding activity for you and baby and will start to be something that baby looks forward to! 

  • Just as your daytime schedule helps everyday look the same, a predictable bedtime routine starting with a bath each night helps baby settle for the night. Following the bath, dress baby, and start the bedtime feeding in their room, or yours, if still room sharing. This should be wind down time, so lower the lights, cuddle, and sing softly if you’re a Nightingale. After the last burp, zip up the sleep sack and place baby on their back in their sleep environment. Allow baby to fall asleep listening to their white noise and self-soothing.  

  • Placing baby in their safe sleep environment awake or drowsy is optimal, so they can drift off to sleep on their own. When baby is already feeling tired and starting to doze it’s a great time to set them down.

  • Follow all of the safe sleep resources mentioned above.

Transition to Sleep Sack

Their startle reflex, known as the Moro Reflex, is fading away, and is much less evident than when they were a newborn (Ince, 2019).  They are also working on controlling their hands and arms and you have probably seen some purposeful movements, like reaching for a toy in front of them. Around this age babies are also getting stronger, and they are likely to roll over between 4-6 months of age. We do not want them rolling in their swaddle, so by 3-4 months, it’s best to swap into a sleep sack or footed pajamas.  

Sleep sacks are a nice sleep association to implement but just pajamas are fine too.  Pajamas and sleep sacks should be made with light weight fabrics; we don’t want baby to overheat and we no longer want to restrict movement.  Once babies are out of their swaddle, they can continue improving their sleep habits through additional soothing mechanisms like sucking on their hands and rolling.

Pacifiers

The AAFP recommends that babies use a pacifier up through 6 months to decrease the risk of SIDS. However, as your baby approaches the 6 month mark, their chances of dental malformations increase with prolonged pacifier use. The complications from providing a pacifier beyond 6 months include displacement of teeth growth and malformations in the jaw, mouth, and palate, which can lead to speech and nutritional complications in future years. While weaning baby off of a pacifier may not be the easiest parenting transition, your resilience in coaching your baby off of the pacifier will help set them up for success later in life. We cover how to wean your baby from their pacifier in the 6-12 month Learning Program.

Baby’s sleeping schedule

It may have been a while since you’ve gotten a full night of sleep.  It’s exhausting… really exhausting.  Hang in there. By implementing healthy sleep associations early on, many babies can sleep through the night about the 2-month mark.  Keep in mind, sleeping through the night, means waking up throughout the night but getting themselves back to sleep.  Baby’s sleep cycles are short, 30-45 minutes initially.  In between these sleep cycles are brief awakenings.  With the helpful constant sleep associations listed below, your baby is able to transition through these sleep cycles more easily and get back to sleep on their own. If your baby is older than 2 months and not sleeping through the night, you are not alone (and you’re not a bad parent and your baby is not a bad baby).  Your coach and our team of experts are here to support you and your family in reaching your sleep goals no matter your child’s age.  It’s never too late.

The American Association of Pediatrics has published 22 recommendations surrounding safe sleep for babies.

According to the American Association of Pediatrics, babies should sleep . . .

  • It’s common for parents to be concerned about choking, but in reality, the baby's airway anatomy and gag reflex prevent this from happening (even in babies with Gastrointestinal Reflux Disease (GERD). If your baby flips over to their stomach feel free to return baby to their back. As soon as baby is able to roll both forwards and backwards you no longer need to worry about flipping baby back to her back. Either way, each time you put baby down put them to sleep on their back.

  • . . .like a crib, bassinet, play yard or device that meets the safety standards of the Consumer Product Safety Commission (CPSC). Never fall asleep with baby in your bed, on your couch or anywhere else. According to the AAP, the risk of sleep-related infant death is up to 67 times higher when infants sleep with someone on a couch, soft armchair or cushion. If this happens, don't punish yourself but remember that this is a sign that YOU need sleep too! Baby is safest in their own crib or bassinet.

  • ideally in the same bedroom for the first 6 months of life. Parents often find it helpful for baby to sleep in a bassinet close to both parents to make nighttime feedings easier in the early months. It’s also OK to put baby in their crib in another room with monitoring. See the resources section below for recommended monitoring tools.

  • No extra bedding, toys, bumpers, blankets, quilts, etc in/on/around the baby anytime they are sleeping unsupervised.

  • . . . to help reduce the risk of sudden infant death syndrome (SIDS).

  • . . . to avoid overheating.

  • Avoid covering baby’s head to reduce the risk of overheating.

Also according to the American Association of Pediatrics, parents should . . .

  • Feedings with breastmilk are recommended as it is associated with a reduced risk of SIDS. Unless your doctor recommends another method or breastmilk production is low, leading with breastmilk feedings will increase baby’s sleep safety.

  • . . .during pregnancy and after birth.

  • . . . like marijuana, opioids, and other illicit drugs during pregnancy and after birth.

  • Maintain ongoing postpartum care after giving birth.

  • Infants should be immunized in accordance with the guidelines from the AAP and CDC.

  • . . . unless recommended by your pediatrician.

  • . . .to encourage motor development. Immediately after hospital discharge, short periods of tummy time are recommended, increasing incrementally to at least 30 minutes daily by 7 weeks of age.

  • If you choose to swaddle your baby (there is no evidence recommending a safety benefit to swaddling, rather it provides a better sleep quality benefit), make sure they remain on their back. See our detailed section on swaddling below for more tips.

  • Ensure that your physicians, clinicians, hospital staff, and child care providers understand, communicate, and exemplify safe sleep guidelines.

  • . . . and ensure that their marketing messages and products adhere to safe sleep recommendations.

  • More information on a specific product can be found on the Consumer Product Safety Commission’s website.

Soothing

Ok, so - you followed the above steps to meet your baby’s needs but they are still letting you know something is up!. What now? It’s simple - keep at it! Rome wasn’t built in a day and sleep habits take a while to cultivate. Being consistent and persistent is key. 

Remember that crying is natural, normal and actually very necessary! Crying is not a bad thing and doesn’t mean you or your baby are doing anything “wrong.” Crying is actually your baby’s only way to communicate a need in their early days. We WANT babies to cry in order to express these needs and let us know when it’s time to help. Your baby’s role is to keep letting you know when they need something so the two of you can begin to understand one another better.

If you’ve ruled out the items in the checklist here… you’re with 99% of parents who have a completely normal, but fussy baby. There are two choices to make around soothing: how to soothe, and when to soothe. For many parents both of these choices can pose considerable challenges as you will never know the “right” answer.  Trust your instincts and use the following as additional tools in your toolkit.

  • Crying can be a major source of stress for parents. We want to make sure that you as a parent feel level headed before trying to support the needs of your baby. As long as baby is safe you can take as much time as you need to compose yourself before attending to baby.

  • Is baby ill? A rectal thermometer is a good tool to keep handy for ruling out fevers in young babies who can't use their words to tell you how they feel. It’s also helpful to check in baby’s skin folds and around their fingers and toes to make sure they haven’t gotten a parent’s hair stuck somewhere uncomfortably. 

  • When were they last fed? How much have they eaten today in total? Referring back to your feeding schedule is key to help baby feel satisfied and maintain level blood sugar (we don't want to try and put a hangry baby down to sleep after all!) We encourage you to use a digital tracker, such as the options listed in resources, to help you monitor the total ounces your baby is consuming (or time breastfeeding). This will help you determine overtime if your baby is getting enough calories during the day (and at the right time of day).

  • are they overtired? Are they undertired? Did they get good rest during earlier naps? overnight? Sticking to the schedule is essential (no matter what happened in prior sleep sessions). We build a schedule based on what is age and developmentally appropriate. Your baby may deviate from the sleep schedule because of travel, a bad sleep day, etc, but the key is to get them back on the schedule as quickly as you can! As the days go on, pay attention to where baby naps best for you for certain naps to help the day run more smoothly.

  • Laying baby on their back and helping them to move their legs slowly into their chest can help move things along in the digestive system

What the research says

While so many changes and adjustments are needed at this age, it is exciting to see baby learn and grow along the way.  A proactive approach and anticipating baby’s needs are helpful to keep baby happy, growing and sleeping well. 

Focusing on baby’s feeds and weight gain early on sets them up for proper development through the years. Consistent maintenance of a healthy weight can help reduce the risk of stunted growth in later years (American Academy of Pediatrics, 2022).

  • Utilizing a sleep strategy that incorporates at least 3 soothing strategies can reduce crying and improve sleep quality for baby (Singh & Menahem, 2023). 

  • Giving your baby massages helps to promote increased attachment between mother and child, as well as reduce pain reception (helpful immediately after baby’s immunizations) and improve weight gain (to reach developmental milestones (Mrljak et al., 2022)

When to soothe

When all of baby’s needs are met, and we are teaching them to fall asleep on their own, they are ideally able to be set in the crib with their white noise, in their sleep sack, and fall asleep independently. This takes time. As you build up to this, MORE soothing is required. You will know the right amount of time for you and your baby whether it's 2 seconds or 2 minutes. Being responsive to baby is critical, but knowing when to let baby try for just a few more seconds to get the hang of a new skill is also something to be very proud of as a parent!  If you decide to go in at 2 seconds, next time wait 4 seconds, the following time wait 8 seconds until you and baby slowly start to build confidence. Whatever goal you’re working towards know that it takes time, and your #1 priority is to be responsive to baby's needs.

How to soothe

Good news here! There are infinite ways to soothe your baby. These soothing tricks also work great together!

Pick up baby

If your goal is to teach baby to fall asleep independently you want to try and avoid picking baby up after they have been placed in their crib. However, it takes time to work up to this goal. If baby is most responsive to being held, hold your baby! The key is to make sure you put them back down in the crib BEFORE they are completely asleep so that baby can start to recognize the crib as a safe place that they are OK to shut their eyes and fall asleep in (without you holding them). If you pick baby up and are placing them back down in the crib drowsy, it's a great idea to supplement this soothing tool with another. Perhaps you pick baby up, calm them down, put baby back down in crib and put your hand on baby’s stomach to rock them a bit more. Or perhaps you add some loud “shhh shhh” with your voice while you’re holding them, and you continue making this noise as you put them down so that baby still feels close to you while they get comfortable in their crib. 

Burp and bounce baby

A few seconds of bouncing to calm crying followed by putting baby back in the crib with a tummy rub may be enough to coax baby to sleep.

Put your hand on baby’s stomach

Put your hand on baby’s stomach, apply light pressure, and rock baby back and forth.

Infant massage

Lightly touch baby’s forehead and face.

Pat baby’s bottom

Rhythmically pat their bottom (only if they’ve rolled themselves over).

Skin-to-skin contact

Skin-to-skin contact - placing your baby on mom or dad’s chest helps babies regulate their emotions. Babies do not have the ability to regulate their own emotions, so as parents, our job is to help them regulate. Skin-to-skin contact is a great way to do this. Research shows that skin-to-skin contact (aka kangaroo care) stabilizes baby’s heart rate, breathing, and body temperature while increasing the time spent in deep sleep during naps and bedtime. It also helps improve breastfeeding and increase their weight gain. These benefits occur with even small amounts of kangaroo care time and can be easily woven into your early morning or after bath time routines.

Try tummy time

Getting some energy out with tummy time can also help with your baby’s fussiness.  Especially with young babies who sleep a lot during the day, it is normal to have a fussy period or (“witching hour”) in the evening. This is their way of expending energy.

Change scenery

Changing rooms, going outside, showing your baby a picture or mirror can help distract them from the current task at hand (i.e. crying!) and refocus them on the fact that they’re sleepy.

About the authors

Melissa O’Neill, BSN
As an RN specializing in NICU and Labor & Delivery for 15+ years, Melissa is also a mother of 3.

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Katie Sardone, PhD, PMH-C
Dr. Katie Sardone is a Licensed Psychologist and the founder of Behavioral Health Dallas, PLLC.

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Margaret Vadiee, PhD
Dr. Margaret Vadiee is a Licensed Psychologist and a former Adjunct Clinical Assistant Professor at Southern Methodist University in the Psychology Department.

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When to get
expert support

If you think you need expert support, this is a great reason to pop into office hours. Sometimes you might need more support, and that's okay!

  • If your baby is not eating well, lacks an interest in feeds, spitting up excessively and/or spit up is projectile or discolored, call your pediatrician.

  • If your baby has a persistent diaper rash that isn’t improving, call your pediatrician.

  • If your baby has a white tongue that cannot be scratched away with your clean finger, call your pediatrician to check your baby for thrush. 

  • If your baby has not had a dirty diaper in over three days or is having hard, pebble-like stools, stool is gray, black or blood tinged, call your pediatrician. 

  • If your baby is turning blue around the mouth or lips, call 911.

  • Always trust your parental instinct. If you feel like something is wrong, reach out to your trusted medical professional asap.

  • If you find yourself feeling down, anxious, or not like yourself, reach out to a mental health professional for support.  You can also call or text the National Maternal Mental Health Hotline at 833-852-6262 (available 24/7 in the US).

  • If you are in a moment of crisis, call 988 for mental health support (available 24/7).

Have a question for your coach?

Schedule time during their weekly office hours! We know not all questions come up on a schedule, which is why your coach is also available outside of the sessions included in your Learning Program.

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