Wednesday, January 30, 2013

When Baby Is Not Sleeping....

When Baby is not sleeping, Mommy is not sleeping.

We need a sleep consultation!

Everyone with kids can relate to this issue, and I'm sure there's good advice out there. I'm open to hearing almost all of it.

The data:

Our Babygirl is 13 months old, perfectly healthy, and very happy. She's a chatty, impish little creature, with great dark eyes, so dark brown they're like Little Orphan Annie eyes- you can't see the pupils. She's adorable; we marvel at her cuteness multiple times a day. She laughs, giggles, babbles and imitates, playing to her fans like a pro. She's starting to toddle, and is so excited about walking, that's pretty much all she wants to do. That, and whatever it is big brother Babyboy (2.5 years old) is doing. She's a great napper, consistently and easily napping 2 hours around midday.

She'll go to bed around 6:30 if we have our act together. If I'm late home from work, or Hubby is late home from traveling, then the whole bedtime routine is delayed and/or fragmented, and sometimes, she's up until 9 p.m. Regardless of when she falls asleep, she's up many times a night, and then up for the day around 6:30 a.m., cheerful, chirpy, and ready to roam.

Lately, she seems to be waking up more then she ever has: one, two, three, sometimes four times a night. She cries until she has a bottle of warm milk. Then, she falls back to sleep, pretty easily.

If we don't go get her, she cries and cries until she throws up, not only requiring a crib change, but also  waking up Babyboy, who then needs to be comforted and rocked back to sleep, and sometimes also wants a sippy cup of juice... in short, total late-night messy disaster.

That is just not Okay.

Though it means sleep disruption, we would extremely prefer the usual (getting up to her crying, taking her downstairs where she will not wake Babyboy, warming up a bottle, sitting downstairs with her while she drinks it, and then putting her back to bed), to the cry-it-out, which results in unacceptable disaster and even more sleep deprivation.

We are, however, becoming very, very tired. I'm wondering if my patients and colleagues can tell how exhausted I am... A few seem to sense it and ask how I'm doing, and Is the baby sleeping yet? I get lots of free advice there too! Meantime, for the first time in my life, I'm drinking coffee in the mornings and the afternoons.

I am grateful to my hubby that he shares the overnight duties... when he is home. He travels a fair amount, and when he is away, I'm on baby-bottle call... This is hard, of course, when I have to be up at 5:30 a.m. three days a week to commute to the Big City to see my clinic patients. When he is home, and I have to be up early, he is on baby-bottle call... though I wake up anyways, as we moms all do when baby cries.

I am also grateful to my mom, who will keep Babygirl overnight sometimes, when Hubby is away, so I can get caught up on sleep.

Despite all that help, I can count on one hand the number of nights I've slept a continuous six hours over the past 13 months. 

I don't know how we got here, as Babyboy was magically sleeping through the night at 3 months of age. Somehow, we have a 13 month old girl who just wakes up alot.

I keep hearing from friends that cry-it-out is the ONLY way to get a baby to sleep through the night. Even if we have to line the bed with newspapers to catch the puke, and even if I have to sleep somewhere else, and even if we will all need therapy, that's the only thing that is going to work...

BUT, the people I know who have done cry-it-out with their own kids recall "those awful nights" with a shiver and some horror, like they're reliving physical pain. My aunt describes doing cry-it-out with her then-toddler son: they padded the walls with mattresses so as not to let his screams wake the neighbors, and then she cried, herself... she says she's still traumatized, and that was 30 years ago....

I just don't buy cry-it-out. We're not going to let Babygirl cry, puke, wake up the whole house, and then end up in therapy ourselves, or at minimum, reliving the horror every time someone else is going through the same thing....

There has got to be a better way.

So, making it clear that cry-it-out is not a viable option for us, I still put our baby sleep issue out there, to see what experiences, and even what advice, others have.

31 comments:

  1. Granted, I do not have a toddler yet, so I'm sure I'm just beginning to learn about how to manage behavior. However, what has helped for me has been to think about how what I am doing reinforces undesirable behaviors in my daughter, and then modify my behavior accordingly. This applies for sleep / night awakenings as much as any other behavior. Good luck.

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  2. I highly recommend the book "Sleeping Through the Night" by Jodi Mindell. I have read it with each of my children (now ages 4y and 14 mos) and have found its advice to be sound, useful, and completely do-able. It addresses many of the issues you raised (toddler not sleeping, dealing with nighttime feedings, toddlers who vomit when left to cry it out, waking siblings...). Best wishes for better sleep for all of you!

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  3. I have another book recommendation, though the book is unfortunately named. It is called "The No-Cry Sleep Solution" and as you might expect, it is opinionated on the issue of CIO and is unapologetically an attachment parenting book.

    BUT

    As a health educator, I have a lot of respect for this book. It gives lots of information about baby/child sleep and even more strategies for dealing with general and specific sleep challenges. The change model it recommends is that you observe your situation (which it sounds like you've already done), you make a plan, you implement the plan for a set amount of time (like a week) and then you reflect, adapt and re-implement your plan

    It doesn't give one size fits all answers. Aside from the AP philosophy, it is not dogmatic or a method you have to adopt whole. It is flexible and personalize-able.

    I have a lot of sympathy for your situation. My kids were lousy sleepers until about 14 months and room sharing and distress from crying made our options limited. You'll get through it. It won't last forever. It won't even last much longer, because you don't want it to and you have the ability to change the situation. You have resources, support and wonderful children! Let us know how it turns out!

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  4. Well, this answer will not be popular amongst doctors, but co-sleeping worked for us. And I now how have two boys who sleep all night in their own beds. (OK, occasionally the little one has a "nightmare" and climbs in with us, but this is not a problem to me.) Some little ones just don't adapt easily to our expectations that they sleep alone. I found it easier to train my kids to sleep alone when they were a little older, and there wasn't much crying involved. I hope you find something that works for you.

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  5. We were co-sleepers also, but by 13 months we were working on getting our daughter into her own bed. We started by night-weaning which actually went fine, but she was still waking several times a night crying. After months of trying to figure out what to do, we realized that she has a milk allergy (trouble sleeping was accompanied by brutal diaper rash, lots of trouble gaining weight). We cut dairy out and within two nights she slept all night long. We figured she was having belly pain that was waking her. She continued to have trouble sleeping if she had even small amounts of dairy (even in baked goods, etc), but now at 3 is starting to grow out of it and tolerate small amounts. It might be worth taking a good look at her diet and seeing if there are any possible culprits there.

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  6. When we were breastfeeding and one of our children continued feeding a couple of times of night despite being big enough that they didn't physiologically require those feedings, I started decreasing the length of time of the feeds night by night (7 min->6 min->5 min etc) Within a week, the night time feeds stopped completely. It just wasn't worth it anymore to them if the interaction was so limited. It's breaking that association with milk + parent = return to sleep. I would try decreasing the amount of milk each night and limiting the nice cozy time with you (or your husband) so it's not so pleasurable and worth waking up for. I really thought the Ferber book was helpful. Good luck!

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  7. My go-to book for sleep issues is "Healthy Sleep Habits, Happy Child" by Marc Weisbluth. It is an excellent read.

    What I gather from your post is that your toddlers sleep is disturbed from being overtired. You don't talk about her daytime naps at all. Is she still napping twice a day? Remember, sleep begets sleep. I think you need to be more consistent with the bedtime - if 6:30pm is too early, and 9pm is too late, why not compromise and pick 7-7:30pm?

    While I agree that the cry-it-out method is difficult at best with a baby in the house, it may be necessary in order to get the toddler sleeping through the night again. When you consistently go into the room, she is learning that no matter how much she cries, you'll get her. Perhaps leaving a bottle of milk in her crib before you go to bed will help? She will wake up, cry, find her milk and go back to sleep.

    Good luck.

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  8. Askmoxy.org has some great discussions about sleep issues.

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  9. I've also heard good things about The No Cry Sleep Solution.

    Mostly I just want to say I'm sorry you're going through this. Not being able to sleep is just the worst. I'm an advocate of CIO, but I think if you've done it to the point where your kid vomits, you've given it an honest try.

    Also, have you checked with the pediatrician for possible medical causes? I know a few babies that slept great after their reflux was treated.

    Good luck!

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  10. This sucks. How long has it been going on? I ask because my son (14 months old) went through a couple 1-2 weeks periods at 11 and 13 months where he woke up crying, drank a bottle and went back to sleep easily. We woke up, fed him and let him go back to sleep and he stopped after 1-2 weeks on his own. We think it was just a growth spurt. He sleeps 12 hours a night now. We've never had to do CIO.

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  11. Hi. I am in the same boat as you! My boy is almost 14 months but was a preemie so about one year old "adjusted." He is a great napper, two naps a day for 1-2 hours and to bed usually around 730-8. Still waking most nights at least once and every few nights as many as 4 times. Try not to give a bottle but do feed usually once. Up around 6 in a great mood. Like you, cry it out resulted in vomiting so thats out. The tough thing is that a quick bottle can mean a 10 min quiet task vs a 45 min ordeal. He does seem hungry! However, our peds thinks he is just a trained night feeder and that it is our doing. We are tired so it is easier to feed than fight. In any event he still needs soothing without eating most nights anyway. We really like the healthy sleep habits book by weisbluth mentioned above, it really helped us get into a good nap/bedtime routine. It is not so helpful with the night awakening since we needed a clear cut plan. He can soothe himself to sleep for naps so not sure why night is so different. I recommend looking into the jay gordon plan. It is a gradual extinction method where you do less and less at night for your child. It requires a week or two commitment and may disturb your other child but I dont see any way around that unfortunately. I think you already realize that you need to be better about a consistent bedtime. One midday nap may work for your baby but most kids still have 2 naps til around 18 months. Have you tried that? I know you hesitate to mess with what is working. Other people have recommended to us to try switching to water rather than milk. We need to refocus on getting our little guy to let us sleep the night or he may never have a sibling! Otherwise he is like the perfect child:) good luck. Please keep me posted.

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  12. Another Co-Sleeping advocate here. When our toddler woke up in the night (many years ago)eventually, instead of crying, he would just toddle into our room (toddler bed EARLY because of that), crawl into our bed and go back to sleep (without feeding). Many nights we didn't even notice because there was no crying. We weaned him to a futon in the corner of our bedroom after a bit - he just didn't like being alone. no fuss, no trauma, no therapy for anybody - but that's just us.

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  13. I knew this would generate lots of discussion and problem-solving suggestions! Thanks so much. I plan to check out some of the suggested books, though we have the Weisbluth book and have not found it helpful... Doesn't anyone else think it is terribly written? Agree with regular early bedtime-- we plan to get on a more structured/ regular bedtime. Naps... I think we're good with the consistent midday 2 hour nap, haven't been able to get two naps out of her for months. Tried diluting her milk- she refused it and cried harder. As far as co-sleeping- tried it, neither kid wants to spend 2 minutes in bed with us. They cry! Both cats end up with us though...

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    1. I read the Weisbluth book when I was up all night breastfeeding, and it made me really mad, and gave me a lot of anxiety. Of course, I might not have been fully rational at the time, given the sleep deprivation and everything. My husband felt the same way though. Fair warning -- the Jodi Mindell book has a lot of the same recommendations, but she's kinder and gentler. I liked the way she framed sleep problems as a "behavior issue" (as you might have been able to tell by my first comment). It sounds like you got some good suggestions though.

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    2. I agree with you that the Weissbluth book is not very well written. He talks in circles a lot. However, I think many of his ideas such as sleep begets sleep, regular bedtimes, etc are very good. I found Ferber helpful for some sleep issues.

      If you don't come up with a good plan on your own have you considered if there is a sleep specialist in your area? A good friend of mine is a clinical psychologist who works with children and families having difficulty with sleep. Maybe having someone outline a plan for you can help. It seems like it should be easier than that, but I have found sleep the most challenging part of parenting so far (my kids are young - 4 mos and 2 years). Good luck! Being that tired when your kids are no longer newborns is so frustrating!

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  14. One middle ground between feeding every time she wakes and CIO is to go in, briefly reassure her, and leave without taking her out of her crib or feeding her. "Night time is sleeping time. Mommy is right here". You could sit in the room with her or even pull a mattress in there and sleep there for a few nights.

    Reducing the amount you're feeding her might also help, but my guess is it's the cuddling and interaction that's the positive reinforcement for waking. She sounds like a social little thing. Good luck.

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  15. I think the problem at this point is that she has had some pretty powerful conditioning to do this at night -- as you might remember, intermittent reward is more powerful than reinforcing the behavior every time. So, the various failed attempts at CIO, etc, will probably have made it even harder to break this habit now. I'm not saying this to sound blame-y but just to say that I think you are in a tough spot and that she is going to be very resistant to change.

    With both of my kids, they went from being decent sleepers at 5-8 months to waking every 2-3 hours to nurse by 9-11 months. It gradually escalated with each of them, I think as they go smart enough to associate waking with getting to snuggle and nurse -- basically I was the one who took a decent sleeping baby and trained them to be a terrible sleeper.

    The second time around we recognized the pattern earlier, and nipped it in the bud with a bit of CIO and replacing me with my husband (no hope of nursing) for all overnight soothing. With my first baby, we didn't start until after a year and the habit was more engrained and much harder to break. CIO didn't really work -- he would cry for hours. We ended up doing a more gradual extinction of the "reward." Dad would go in to sooth instead of me, and initially ended up laying in his crib with him (!), then laying on the floor by his crib and patting him until we were gradually able to remove him from the room. After we'd broken the nursing association, there were still times where the night wakings would escalate and we'd then have to do a few days of CIO. However, this worked much better once what he was crying for was a pat on the back rather than a full tummy of milk.

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  16. I love this post, have not read all of comments. It reminded me much of my two kiddos - C slept through night at 3 months (I'm such a good mommy, ha ha) and J was up feeding 3-5 times a night until 8 months. I had to stop it, and I didn't have time to read entire books on the subject. I was desperate - needed to start studying for my boards and it was a bad point in my marriage. I let him cry it out. It took a week. I read online it was better to do this at 5 or 6 months - felt I had waited too late. I had to have a space heater in my room to block out noise. No vomit, but he was hoarse every morning at breakfast. I cried all night long that entire week. I don't know who needs more therapy for it, me or J. Probably me:) But it worked. He is happy and well adjusted now. I hope to goodness you find a better solution for you. Good luck Cutter! We have such similar kid experiences.

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  17. This is going to sound so simple, but no one has mentioned it. Could you try adding a bottle just before bed? Perhaps it will help her sleep through the night. We also used rice or cereal in the bottle as needed. A big 'no no' I hear, but the only thing that kept us sane.

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  18. My oldest was a terrible sleeper - we ended up doing co-sleeping with musical beds until he was 19 months old so that we could all get some sleep. We tried a lot of things, but what finally worked was leaving him in his crib, and then sitting next to him, occasionally patting and shushing. The first night he screamed for 2 hours, which was pretty much hell, but I was there, patting him, so at least I didn't feel like I abandoned him. The next night he screamed for about 45 minutes and then slept for 5 hours. The next night he slept for 7 hours straight. I had tried straight CIO before, with similar results as you had. Actually I'm amazed we even had another kid after that experience (fortunately kid #2 has been a dream sleeper in comparison).
    I had read the No-Cry Sleep Solution, but nothing in there seemed to help, but I did find helpful information in The Sleep Lady's Good Night, Sleep Tight: Gentle Proven Solutions to Help Your Child Sleep Well and Wake Up Happy by Kim West. This was pretty helpful with getting him to sleep without having to nurse him or hold him until he completely fell asleep.
    It's so hard, and I hope you find something that works for you!

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  19. I am very much against CIO. I cannot imagine anyone would advise a parent to allow their child to cry until she vomits. CIO is never the only option. I am an attachment parent, and my AP and crunchy moms never use CIO and get great results.

    Our first was still breastfeeding every 2 hours at night at 15 months because he was a reverse feeder. I was co-sleeping because this was the only way I could still be functional the next day, but I was getting exhausted. So we first night weaned. He was offered a bottle at first, then bottle of water. He quickly stopped asking for a bottle. When he would cry, my husband would carry him around until he stopped crying. We put him to bed in his bed which was (and still is) attached to our bed, but on a lower level. It took about 5 days for him to sleep through the night.

    One thing I realized from co-sleeping with my first was how much I actually enjoy co-sleeping. I love the extra cuddle time! Now I co-sleep with my second, who has been sleeping through the night practically since he was born.

    Good luck to you, and don't believe for a second that CIO is the only solution.

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  20. Thanks so much everyone for all the comments- so appreciated! There are many tips here that we may try employing, first will be being more consistent with an early bedtime; second will be to try to limit the milk/ time with her at overnight feedings. Loads of support here- Thanks!

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  21. I don't have great advice to give, really, just sympathy. I've got 5 kids and I think I've slept through the night only a handful of times in the last 10 years- literally. Cosleeping is helpful if your daughter will settle down with you- but without nursing, may be tougher. I find that the only way I can get through it is to discipline MYSELF to get to bed earlier- then I have more of a buffer with the frequent wake-ups and am not so crazy tired in the morning. Last night, my one-year-old only woke up twice- and I was so excited!

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  22. No good advice here except that I feel your pain! My 3yo was and still is an awesome sleeper, and my 16-m little guy screams and cries until he vomits. The record time for changing his sheets in one night is 4 times. My husband even bought a carpet cleaner as a Christmas "gift" because the carpet in my son's bedroom is getting pretty crusty despite our best efforts to scrub after each episodes of vomit. I found that putting him to bed earlier helped a little bit but is not consistent. We no longer give him a bottle and that has decreased the vomiting but not the waking up. =( Good luck!

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  23. Mary Sheedy Kurcinka's book "Sleepless in America" was one I found helpful - it's not just about babies/toddlers though, but all ages, and focuses a lot on making sure that kids (and everyone) are getting enough sleep (my 3 yr old is one who gets super-hyper if she's overtired, leading my parents to say on more than one occasion when she stayed up late when they babysat "but she didn't seem tired at all", when in fact she was beyond tired) - so focuses a lot on daytime and bedtime routines that promote easier and better sleep. My daughter tends to wake up more at night when she had a harder time getting to sleep and if overall she's overtired - it always seems that just we get her back on track, then we go on holiday and bedtime's messed up and she's more tired again - so wakes up at night more again, and on it goes.

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  24. Just wanted to mention that I don't think CIO is traumatic for everyone. Yes it's hard, but I certainly don't need therapy, nor do I cry when I think about it now. (My son is 10 months and we sleep-trained him at 6 months.) In fact, I'm pretty much only grateful that I had the courage to do it and stick with it for a couple pretty rocky months, as he has now been sleeping really well for the last 6 weeks, and I feel like a much healthier saner mother. And my son is so much happier now that he is getting the sleep he needs.

    Anyways, I do wish you luck, not sleeping is so hard! Since you have read some of the books and not found them helpful, I would also suggest seeking out a sleep consultant who will work with you without CIO in your area? A friend of mine has just hired one in our area that supports her decision not to CIO, so they are out there.

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  25. What about a "modified" cry it out. We were beyond exhausting and it took us about 2 weeks to work things out. Either way you're going to be tired so might as well put in the hard work for 2 weeks and then expect good results. First, seems like the warm milk and being carried makes waking up a very comforting thing. A Child Psychologist I worked with helped us figure out how to make waking up alone a less "scary" thing and how to make putting himself back to the sleep the norm.

    Our plan:
    We cut out the nursing/ milk at night and transitioned to a bottle then a sippy cup with water only. Whenever Zo wakes up at night, we set the alarm to allow 5 minutes of squirming and crying. Then we go in and soothe. We never ever ever take him out of the crib, just back rubs and head rubs and then lay him down and pat his back/butt for a minute then leave. We give 10 minutes alone then offer the water and repeat the rubbing. Then 15 minutes alone. 15 min is our max. First few nights he made it to 15 min, by the end of the week he wasn't interested in night time waking.

    We modify the plans during illness and travel but it's worked pretty well with a few bobbles along the way.

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    1. Thanks Mommabee- have been trying here and there to transition to a dilute bottle to start, she has rejected and cries harder. Tried just rubs- I just break down when she screams and screams. I think we are just primo wussy. Will kep trying, esp with what GuideMD suggests- getting them to bed earlier.
      Thanks all for great suggestions- Genmedmom

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  26. I totally did not read every comment, being much too busy looking after my three kids and going to work as a paediatric surgeon :)
    Just my five cents here: Do not (ever!) disturb a working system. My kids are lousy sleepers. From day one. No napping except I hold them. So, no napping :). My gifted and very, very intense little daughter is six now, and she still does not sleep through the night, most nights. But she is mature enough now to get herself back to sleep, get herself a drink, go to the loo and stuff. Doesn't need me anymore. I still wake up, hearing her, since I am probably a bit paranoid, I am waking up with every move of any of my kids. My four year old son is sleeping through most nights, but won't fall asleep alone. So, he falls asleep next to me, which I see as bonding time, not much bonding time during these madly busy days, so I figure it's a good thing. Daddy is carrying him to bed afterwards, that works really well. (he comes back every night, though, but he just crawls into bed and doesn't need me, so I count this as sleeping through the night - I guess it's all about definitions :) )
    Littlest: 14 month old and probably years before sleeping through the night. She wakes up often. I breastfeed her, so she sleeps next to me in her crip. If I feed her, she falls right back to sleep, if I don't - hell breaks loose. I need my sleep to function, I cannot be not concentrated standing in the o.r. So - no sleep training here.
    I cope with just giving everyone what they need. And - sometimes I am exhausted and think there must be an easier way. But mostly, that's when they are exceptional needy, and mostly, there is/was a reason for it. Like a major growth spurt, mentally or developmentally. Or (like last week) four teeth at once.
    I learned with time, that I just follow the flow, and do what works best for us. And - eventually, they won't need you anymore - and you'll loose sleep about that! I don't worry about any books or counselors or basically anybody anymore. They don't live my life. If night time is the only real quality time I spend with my babies - so be it.
    (BTW - as a pediatrician -yes, I am double trained ;) - I do believe in cosleeping)

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  27. Well I do not have any good advice, only to say that I read all the sleep books, and I have one child who sleeps and another who doesn't and I came to the conclusion that some children are better sleepers than others and nothing I can do will change that.

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  28. I know this post is a little old but with my daughter whose 2.5 yo. She just started sleeping in own bed for last 2.5 yrs she's been co-sleeping with us. 13 mo is a little young and she went through the same phase of waking up and crying a little milk like you've mentioned and a little tlc will do the magic. I do not believe in CIO mehtod. It gives ne heartache when I hear my kids cry so I go to them right away unless I'm driving and its late at night. I just let them cry for our safety so we can avoid pulling over in unsafe areas.

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