Although I started to write about the 4-month stage transition yesterday, I want to return to the 8-11 month old stage we've already touched on for a reader's question. I've got a few thoughts about the issues she raises and then I'm hoping that the rest of you can chime in with additional suggestions/words of advice/encouragement. I. is a mother of an 11-month old who has had severe reflux problems from birth. She wrote:

Right now, his good nights look like this:

10:00 – Nurse. Asleep by 11:00, in his crib.

12:00 or 1:00 – Wake up. Nurse for 20 minutes, followed by
20 minutes of holding to get into deep sleep before he goes into his crib. (If
he's put down before then, he cries and we risk a complete wake-up.)

2:00 or 3:00 – Wake up. Nurse for 20 minutes. Go back to
sleep, but only on a person; at this point, he just will not go back to sleep
if he's not with a person, so one of us ends up sleeping in the recliner with
him.

7:00 – Wake up for the morning.

And on his bad nights, anything can happen – he doesn't go
to sleep until 12 or one, then he's up every hour all night long, with an hour
and a half in the middle of the night where he's totally awake and ready to
party. Or he just won't sleep at all except on a person.

He tends to make up for it by sleeping more in the daytime;
after bad nights, he'll get more sleep during the day (always and only on a
person, though; I cosleep with him at every nap, because otherwise there is no
napping) than he did at night.

It's not really a sleep pattern so much as a sleep
dysfunction at this point. We'd cheerfully cosleep with him in the bed if we
thought it was safe, but our bed is really high and has no rails, so he'd have
to sleep between us, and we're both large people and my partner is a heavy
sleeper, so we're a little worried about that. (One possibility would be to get
a new bed, or to get bed rails for this one. If that's what it will take, we'll
do that.)

Our pediatrician has advised crying it out. But intense,
long crying spells tend to lead to reflux episodes, which leads to a) more
crying and b) vomiting, and by the time he's soothed, cleaned up, and changed,
he's awake,
so crying it out seems like a bad idea for him. (Also, I really don't
think we can take it; time and again, we've been the parents who caved
after a minute of crying. We'd both rather be up all night than let him
cry, in all honesty.)

Other people keep telling us that it's the nine-month sleep
regression, but – he's eleven months old. It seems like this is more than that.

Any advice would be very, very welcome. I'd especially welcome
suggestions for a sleep training method we can use, and some idea of
when to start it, and any ideas about what we can do in the meantime."

Oh man… this sounds so hard for everyone: your poor baby and his "growing pains", what with the reflux, teething, and first cold and poor you coping with trying to soothe a baby in pain all the while terribly sleep-deprived . As I see it, there are many parts to this sleeping "question":

1. Reflux problems and the associated sleep situation that requires mom or dad to sleep with the baby upright on a recliner.

2. The child's developmental age.

3. Frequent night wakings, sometimes completely unpredictable.

4. The child being overtired when nights are bad and compensating with longer naps during the day.

5. The desire/need for you guys to co-sleep but the obstacles therein.

6. The need to change the sleeping situation with an appropriate method that works for the whole family.

PHEW!  Did I get it all? It really does seem like some change is required for the whole family to get more rest and feel better. I know there are many parents out there who have dealt with reflux
problems and have found various solutions along the way. Given that you've been dealing with reflux problems with your boy since birth, you're probably an expert yourself by now. That's not my
area of expertise, so I'm hoping others will join in with their words
of wisdom on that front.

So, let me start with #2: Even though he's 11 months, he most certainly still can be in the throes of this developmental transition that starts around 8/9 months. He should be heading out of it soon, and in the next couple of weeks, you can start trying to implement a new plan. IOW, it's good timing to make a change.

#3 and 4 are connected. The frequent night wakings may be in part a function of your child being overtired which, in turn, has an impact on his napping situation, and so on. You may have heard from way too many people that children often have a harder time going down, sleep fitfully, and LESS, when they're overtired. Although Weissbluth seems to suggest that this is a new insight, our grandmothers and nannies have known this forever. My first suggestion to you would be to try to put your baby down "for the night" at an earlier time, especially given how early he still wakes up (7 am). Some kids wake up late (at around 9pm) and so they go to sleep for the night later as well (10 pm or so). This difference in sleep windows is often culturally determined and often reflects a preference for later nights and mornings on the parents' part (as well as the child's). That's all good if the child is getting adequate amounts of sleep. But in your case, that may not be the case given your description. So, my first suggestion would be to try aiming for a significantly earlier bed time, like 7 pm or 8 pm. You probably won't be able to make this change immediately (although it may be worth a try). So, you can gradually inch his bedtime earlier and earlier over the course of a week or two. Although not all babies respond well to this, many do. And counter-intuitively, many babies sleep longer when they're put down earlier.

#5 may be the most straightforward one to tackle. If you and your husband want to co-sleep and you think this will be the best way for all of you to maximize your sleep, then go for it. If you can afford a new, bigger bed that will make everyone more comfortable this may help. Some bed rails may work, but I'd be cautious about how safe they are for wriggling, soon-to-be toddlers. Also, keep in mind that this is a change in your sleeping situation that may last for a long time. If you and your husband like the idea of long-term co-sleeping, great. But if you want to just do it for a month or two to get out of a "bad patch", then you might want to consider what your ideal sleep situation would be instead and work towards that. Your baby is entering a great, relatively stable, resilient stage very soon. This new stage is a window during which you can shift sleep patterns; a lot easier than making changes during the 18-21 month period!

Finally, #6: I'm not big on advising any sleep-training method over another without knowing a family very well. My approach is more along the lines of providing all the possibilities and letting you choose what best fits your parenting style. In our book, I reviewed the main sleep-training methods and the pros and cons of each (it would take pages and pages to do that again here and it probably infringes on some copyright issue or another). You're obviously not into CIO methods, so stay clear of any of those. For the life of me I can't understand why pediatricians advise families to carry out sleep-training methods that go against the parents' own general approach: it's insensitive for one, there's no empirical research to suggest any of the more extreme CIO methods work any better than the more systematic non-CIO method, and the advice is doomed to fail if parents don't feel comfortable following through with the method consistently.  (Gah. I'll get off my soapbox now. Sorry.) More importantly, full-out CIO sounds like it would not be a good thing for your baby, given his serious reflux problems that get exacerbated when he cries a lot. There are gentle, "no cry" techniques that have worked for many families (Pantley is the guru for this approach). These are methods that allow you to gradually change sleep conditions while still providing some level of comfort and support for your baby. There's more graduated methods like Ferber's, that does allow for kids to cry, but for short periods that you can control. Other "controlled crying" approaches suggest allowing the child some fussing and crying before falling asleep, but remaining with him while he does so. And of course there's various co-sleeping arrangements, which the Sears folks have written about extensively.

Can anyone suggest specific methods that have worked for you in a similar situation? Any words of advice for I. on transitioning to a co-sleeping arrangement? What about the problem of reflux and how it fits into solving these sleep problems?