But once you give your child the developmental benefit of the doubt (and before you decipher her specific sleep issue), consider her nursery's safety status. An awake baby is more mobile than a sleeping one, so remember:
- Lower crib mattress to its lowest level.
- Keep rooms at modest temperatures (68 to 72 degrees is ideal) and babies from being overbundled (as overheating is a SIDS risk factor).
- Avoid lots of toys in the crib.
- Remove crib bumpers and quilted blankets (due to SIDS risk), plus crocheted blankets (which may have loose strands that could choke a baby).
- Never allow smoking in the house.
What the Docs May Do
When I discuss this issue with parents in the office, the first thing I do is to walk through their bedtime routine with them: "What do you do? And don't spare the details." It turns out that at this age, the last part of the bedtime routine is critical. Infants at nine months can make strong associations with their environment at the time they fall asleep. So an infant who falls asleep rocked and cuddled, can grow to need that rocking and cuddling to fall asleep. Because infants wake and return to sleep many times each night, your bedtime routine can result in an extra effort on your part (rocking and cuddling, in this example) many times each night as your infant wakes up and doesn't know what to do with himself.
Feeding, like motion, is another example of a parent-provided stimulation. For infants who bottlefeed or breastfeed as they fall asleep every night, I encourage parents to move the feeding to an earlier part of the bedtime routine. Instead of bath, tooth brushing, reading, feeding, then bed, I suggest feeding, bath, tooth brushing, reading, then bed. Pacifier use, white noise, or bright light in the room during sleep initiation can cause a similar problem. This issue of "cleaning up the bedtime routine" teaches your infant self-settling—a developmental task that all babies must learn.
Your pediatrician can discuss with you the many ways to promote self-settling. There is The No-Cry Sleep Solution method by Elizabeth Pantley or the Solve Your Child's Sleep Problems method by Dr. Richard Ferber, MD. These methods get to the same end point but with different pros and cons. My favorite book on the subject is Dr. Marc Weissbluth, MD's Healthy Sleep Habits, Happy Child. Dr. Weissbluth's book helped me through three sleep-deprived infancies.
Your pediatrician may ask you to keep a sleep diary. This is a detailed log of every fall-asleep time and wake time (including naps) over the course of a week. Oftentimes sleep logs are full of information that helps your pediatrician get to the solution more quickly.