This week, on the Kids Sleep Show Podcast, we cover the 4-month sleep regression. It is a huge challenge for so many parents, especially as many transition back to work, and sleep struggles amplify with short daycare naps and support to sleep. Today, I dive into what causes the 4-month sleep regression and an actionable plan to get past it and move on to a balanced bedtime, the ideal 4-month-old nap structure, and the ability to maximize daytime intake for your 4-month-old to sleep through the night. Happy Listening!
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Episode Highlights:
- What causes the 4-month sleep regression
- Signs you are in the 4-month sleep regression
- Developmental changes at 4 months old
- How to get over the 4-month sleep regression
Sleep Struggles Solved + Results Guaranteed
Welcome to the Kid Sleep Show podcast where we dive into the magical world of sleep and all things parenting. Join us as we embark on a journey filled with expert advice, practical tips, and heartwarming stories that will transform your little ones into sleep superheroes and empower you to navigate the beautiful chaos of parenting. I’m your host, Courtney Zents, and I’m on a mission to change how the world views sleep and provide accessible sleep coaching resources for all families to build healthy sleep habits in their home for children and adults of all ages.
As an award-winning speaker, author, and pediatric sleep expert, myself and my team of consultants work intimately with families around the world to teach healthy sleep habits to children and adults. I believe wholeheartedly that sleep is the foundation for which a happy home is built, so let’s sleep together. Hey everyone, welcome to this week’s episode.
I’m your host, Courtney Zents, and this week we are talking all about signs of the four-month sleep regression. So this is a huge challenge for many parents who have this wonderful newborn that comes home from the hospital and sleeps a lot and eats a lot, and then all of a sudden, between three and four months, they start to have more challenges in sleeping. So if you’re here and you’re listening and you’re going, hmm, I might be there, let’s talk about it.
So first and foremost, the signs that you’re actually having a sleep regression at the age of four months versus normal developmental patterns are going to be as follows. If your child was normally sleeping really well overnight, maybe around three months, they were waking two to three times to eat, but then they would go right back to sleep. Maybe their naps were a little bit more supported but easy to get down, right? So oftentimes when you have the four-month sleep regression, what starts to happen is you notice, hey, all of a sudden around four months, they start waking more frequently overnight, lots more middle-of-the-night wakings.
Their nap patterns change. Maybe they’re not settling as easily at nap time. They’re fighting going down for the nap.
You inevitably have one nap of the day that’s really short. If they skip it, then they’re kind of a mess for bedtime. There’s a lot of crying, a lot of protest and upset at put down, and then they only end up ever being able to fall asleep if they’re being held or fed, and then when you try to transfer them into the crib or the bassinet, they wake back up startled, and the whole cycle starts all over again, and you’re sitting there going, are they hungry? Are they overtired? Did I get a burp out? Did they poop, right? You start asking yourself all these questions because you’re trying to figure out, hey, what is going on and how do I get past this because I feel like a big mess and I’m tired, but more importantly, my baby’s tired and they’re strung out, and I can obviously see that I need to get them to burp.
So let’s talk about it. So those are your signs, right? You’ve got frequent night waking, short naps, trouble settling, upset, and then really what ends up becoming the only way to get them down is some aspect of supported sleep. So I want to talk first about the sleep science and the development of sleep at four months old that will help you to better understand what’s happening with your child right now because there’s a couple changes that are developmental that can lead into a four-month sleep regression, and then there are things you can do right now to start to fix that so that we can get rid of it, you can move past it, and you can forget that it ever even happened and get your child settling independently and then help your four-month-old to sleep through the night as appropriate, feeding where necessary, which we’ll talk about.
So the first thing I want to discuss is sleep development, right? Between three and four months, you’re moving out of this newborn phase of sleep into a more patterned cycle-based sleep. So the first three months of life, newborns sleep in 50% REM and 50% non-REM sleep, okay? It means that it is either really deep or really light. So maybe you’re used to them sleeping a lot during the day, which newborns do, and then they actually are sleeping pretty good overnight.
You feel like, oh, maybe this time we got a really good sleeper. So then what happens is between three and four months, they move out of that stage-based or cycle-based, no, excuse me, stage-based sleep, 50%, 50% over to cycle-based sleep, right? So what ends up happening is their body is now producing hormones to keep you in balance, right? You’ve got cortisol in the morning, melatonin in the evening. Then you have normal cycles, right? So 45 to 60 minutes typically is like the average sleep cycle for a baby, right? So now they’re moving from stage-based sleep to cycle sleep.
Well, what happens is they’re now passing through more frequent number of cycles moving between REM and deep stage four sleep, okay? But if they’re used to a lot of support to get to sleep, that can cause more frequent waking. So if for the first couple of months you were like, all right, well, you know, they fall asleep in my arms and I transfer them and it’s no problem, that can start to get harder, right? If you’re feeding them to sleep, nursing them to sleep, rocking them to sleep, anything with the term to sleep starts to become a challenge right around now because they are now expecting that that’s how they fall asleep. So you see an increase in wakings because they’re passing through the cycles more frequently now going, oh, I need your help to sleep.
Oh, I need your help again. Hi, me again. Can you feed me to sleep, right? So when you move from stage to cycle sleep, you can often see an increase in waking, which people then easily call a three-month sleep regression or a four-month sleep regression.
So it’s often stemming from the fact that you had a developmental leap from stage to cycle sleep that creates changes in their sleep pattern and then thereby can challenge how they were going down initially that they’re no longer kind of wanting to do now or that you as a parent are like, okay, we have to get past this. I can no longer be rocking you to sleep every single time, okay? So you have stage to cycle sleep. The next thing you have to look at is your timing and what your day and nights are looking like.
As a professional sleep consultant, I really try to focus on a seven to seven type day because it’s most naturally aligned with the sun, which ocularly will start to help your child’s circadian rhythm develop with balance, okay? So when you start to look at timing, if you’re somewhere between a seven to seven day or an eight to eight day, that is really the range that I will work in. Anything outside of that starts to get a little more complicated. It’s doable, but it’s really starts to get complicated.
So we try to work off the natural body clock. So seven to seven, okay? And then you have to look at how the timing works at four months old. So if you come to me and you say, my four-month old will only stay awake for one hour, I can tell you your timing’s wrong.
You have multiple night wakings, I’m sure. There’s a whole lot going on, right? Because biologically, they have what’s called sleep pressure or the increase in adenosine. So adenosine is a neurotransmitter that kind of tells your brain, hey, it’s time to go to bed.
But if you don’t take a nap, it gets overstimulated because it triggers adrenaline and cortisol. It thinks you’re trying to stay awake, right? So the timing is really important because you have to have enough adenosine to take a good nap, right? Which for four months old should be about somewhere between 90 minutes and two hours, okay? But if you have too much and the child then gets overtired, then they get overstimulated and they really struggle to go down. So it is a very, very fine line between undertired and overtired at this age that can cause challenges.
And I will tell you that timing in the day absolutely feeds how well your child sleeps overnight. Sleep begets sleep, okay? So you have to look at those wake windows and manage that overtired because for the next five years, overtired is the worst thing that you can do to a baby, to a toddler, frankly to an adult, because your body is trying to stay in balance with the hormonal aspect of like melatonin raises during bedtime slowly decreases overnight. Between four and six in the morning, you have your lightest stage of sleep, your coldest body temperature, your highest levels of cortisol.
And so your body’s trying to kind of combat that. And then if you get into overtired, you often see trouble settling at bedtime, multiple night wakings, early morning wakings, and then your whole day is set off kind of wrong because now you’re probably trying to feed to sleep in the middle of the night. Well, gosh, they’re waking so much more.
Maybe they’re hungry, right? So that’s really important because I want to talk about intake needs. Newborns really eat the same amount, honestly, that a 12-month-old does. It’s just their capacity is different.
When they’re born, they have a belly that’s the size of a walnut. And then from three weeks to three months, it’s about the size of an egg, okay? And then from three months to six months, you’ve got a nice orange, and then it becomes a grapefruit, and then a cantaloupe, and then that’s where you are. So the total amount a baby eats the whole first year doesn’t change.
The frequency in the feedings will because a walnut can only hold so much milk compared to an orange, right? So babies need 24 to 32 ounces of milk, breast or formula, in a 24-hour period for optimal growth, okay? When a baby gets 24 to 32 ounces in the day, has the skill to put themselves to sleep, has the right timing in the day to feed a good bedtime and overnight, and has the right balance of overnight expectation, okay, that is when a child sleeps through the night. So it’s skill, timing, intake, right? Those are really the variables that we start to look at. Now, we have to look at other things because babies at this age have a lot going on.
Are they not eating as well during the day, and at four months old, the most they’ll take is two ounces? Okay, well, that would be a red flag to me as a sleep consultant to say, okay, what are they doing overnight? So let’s look at their intake, okay? And we kind of isolate like, hey, are they going to the Vegas buffet at two in the morning, and four in the morning, and six, and 10, and 12? And if they’re eating half their intake overnight, well, then sure, they’re developmentally getting their nutrition overnight. We do have to slowly get that into the day, but we have to protect the fact that they are hungry in the middle of the night, right? So you have to look at what’s happening overnight. And then if there’s still a challenge where you’re like, well, they’re not eating a lot overnight, but not eating a lot during the day, is there evidence of blood or mucus in the stool? Do they potentially have a milk protein allergy? And that’s why their belly’s actually like, this is not good for my belly, and I don’t feel good, so I don’t want to eat, right? So sometimes the notice of like a mucus or blood in the stool is a sign to call your pediatrician, because you might have a milk protein allergy if they are on formula, or if they are breast milk, and you are consuming dairy products.
Okay, so that’s just a sign for that could be causing some agitation and discomfort. Sometimes you have to look at hypoallergenic formula, and then you have to find the right one, because if it’s causing agitation, upset stomach, gas, like all this different stuff, like it’s uncomfortable, so then they don’t want to eat. So like if you have a four-month-old that’s ending the day with maybe 17 ounces of milk, but still only taking like two feedings overnight, and you’re still on the lower end of that total, like that would be a conversation to have with your pediatrician about like, hey, what is going on? Because at this age, they should be taking more and have the ability to, you know, maybe a wake once, I’ll give you a twice at night, but anything kind of over that at four months starts to become a, you know, an intake balance, and then making sure that there isn’t something else going on.
Just in my experience, I’ve been a sleep consultant for over 10 years now, and I see a lot, and sometimes it’s missed at the doctors, and I am not a doctor, but you know, I can see red flags and patterns of things where, you know, it’s like, you might want to have them evaluated for a lip tie or a tongue tie, because sometimes those are missed as well. Their mouths are so tiny. When they’re born, it’s hard to get in there and see if their tongue is too fused to the bottom of their mouth, and they need to do a release that has to be done typically.
Pediatric dentists will do it. It’s very a quick procedure, but if their tongue can’t release from the bottom of their mouth, it can cause a challenge in eating as well, so there’s a lot of variables that you want to, like, look at. You know, I know that for my own daughter, I mean, she rejected my breast milk, so I ended up pumping every three hours for about nine months.
I had an entire humongous chest freezer full of frozen breast milk. I could not figure out as a lactation counselor what in my milk she was just pissed about having, right? She would slam formula from Costco like a boss, okay? She would scream for two hours after every feeding when I fed her breast milk, and what’s funny is it wasn’t a milk protein allergy, because she would drink the normal Costco formula, and I’m like, what is this that is causing so much agitation? We never did figure it out. The lactation counselor couldn’t, the pediatric dentist ended up snipping her lip and tongue tie, but still there was upset.
There was no mucus or blood in the stool. The lactation counselor, the pediatrician, like, I mean, I had everybody on top of it, and I was lactation counselor, and I still couldn’t figure out with her what the heck was going on, so I just pumped, and then I tried to, like, do a little bit of breast milk in with the formula. She would freak out, so there was something in my diet that to this day I never really figured out.
I eat almost a whole clean diet of, like, heavy greens and stuff, so it might have had something to do with that, because it was not a dairy thing, but it is just every child’s different, and you just never know. You know, my son was great. We did exclusively nursing and pumping for nine months.
He bit me. I squealed like a circus pig, and then he never nursed again, and that was the end of our journey, you know, so it’s a lot happening the first year of life, and I just want you to give yourself grace, but try to look at variables you can control with a four-month-old and variables that you can’t control and go, okay, developmentally, the wrong nap schedule is a challenge, but also developmentally, they don’t have the ability at this age to consolidate naps. That is not yet something that happens.
That’s typically between four and six months. Once they go from stage to cycle sleep, they then have the ability to consolidate naps, so between four and five months, what I usually do with my private sleep consulting clients is I will have them do the first feeding, or excuse me, the first nap would be independent in the crib. The second nap we would do supported to protect overtired.
The third nap we’ll do independent, so they get the practice of the skill, and then the fourth nap we would do supported because that’s usually the nap that, you know, is towards the end of the day, the hardest one to get, so that would be kind of how I would look at a nap schedule for a four-month-old so that you protect overtired. You help build skill, so they have the skill to settle to sleep, which is going to feed ultimately how well they stay and go asleep overnight, right, and then it gives you the right balance to avoid overtired at bedtime because I can’t tell you how many people try sleep training a four-month-old, and they’re doing it with the wrong pieces of the puzzle, so it’s not as simple as, oh, just pick this method and sleep train your kid. Like, you’ve got to look at all these variables and understand how to protect that sleep and make sure that if your jigsaw puzzle’s missing a piece, it’s not going to come together, unfortunately, and you’ll have a kid that cries for hours, so you definitely don’t want to do that.
So, if you are in the four-month sleep regression right now, try to look at your schedule, try to look at your ounces, try to understand what baby’s getting. If you’re exclusively breastfeeding, I encourage you to either do a weighted transfer at the pediatrician where they’ll weigh baby before, feed, and then weigh them again right after, and you’ll see how many ounces they transfer, or grab a scale off of Amazon. You can get a really decent, super sensitive scale for babies that’s like 60 bucks on Amazon, and it will allow you to do weighted transfers throughout the whole day, so you can see how much milk baby is transferring.
Some of baby sleep is a numbers game. They need the right intake. The rest of it is the balance around the naps, and then the third part’s the skill.
So, if you can kind of take out the variables that you can control, you can make educated decisions on why your four-month-old is struggling, why they are in a sleep regression, why your four-month-old isn’t sleeping through the night, so you can kind of take a look at all these things to go, okay, let me start here because our timing is good, our intake’s good, but they require me to put the pacifier in 75 times a night. That’s probably the root of your problem, okay? So, I hope this episode is helpful and has opened your eyes to some things that might be happening for your four-month-old. As always, here at Tiny Transitions, we are here to help.
We offer free discovery calls to talk to you about your child, what’s going on, to see if it’s appropriate that you might benefit from sleep coaching with us. We have a lot of different options to do that, so I encourage you to head out to tinytransitions.com and book one of those free calls. Thanks so much for listening.
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Here’s to better sleep, brighter days, and healthier, happier families.
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