00;00;00;00 – 00;00;21;03

Dr. Mona

Around the age of 11 months, 12 months we can see intake decrease. So with food, with milk, but definitely with food that your baby, who may have been feeding and eating a lot more, could drop in their intake because this has to do with just their caloric needs in general. So to avoid this calorie anxiety and this sort of like I don’t trust it.

 

00;00;21;03 – 00;00;40;27

Dr. Mona

Like what’s going to happen? Keep the schedule and then also make sure that you are offering the variety at meal, at snack. And then your reassurance is going to be those checkups right? With the doctor. You’ll go for a visit. You’ll see their waking. If you’re feeling like in between visits, there’s poor weight gain. You can always go in just to get a week check and talk to the clinician.

 

00;00;41;03 – 00;00;56;17

Dr. Mona

But you are going to have that schedule be your best friend in terms of providing you the reassurance that I am offering. My child is food and he or she is going to decide what he does with it. But another thing is coming when it’s set to come at the time.

 

00;00;56;20 – 00;01;15;11

Dr. Mona

Hello and welcome back to the show. I am Doctor Mona and thank you so much for tuning in for today’s episode and for all of the episodes you download and listen to. This is what makes the podcast continue to grow your downloads, your reviews, your ratings, and also how you share this podcast with your loved ones and on social media.

 

00;01;15;14 – 00;01;39;26

Dr. Mona

On this episode, I am chatting with a mom from the PDT community, Kate, and we’re discussing toddlers and night feeds, sleep associations, and calorie anxiety. She has a 13.5 month old boy who still gets a bottle right before bed and also at 4 a.m., and she is concerned if she can wean these bottles, will he get enough to eat in terms of calories throughout the 24 hour period?

 

00;01;40;03 – 00;02;00;24

Dr. Mona

And if toddlers really need to be fed overnight? So tune in as we talk about these issues. Also, don’t forget that here at PedsDocTalk, I am launching toddler courses in May of 2023. So if you’re listening to this in April when this episode launches, make sure you join our email list so you can get notified when the course goes on sale.

 

00;02;00;27 – 00;02;27;07

Dr. Mona

And if you are listening to this after the first week of May or May 1st to May 5th. It is available for purchase. The courses go over a potty training, feeding toddler so things like picky eating, food refusal, as well as another course on toddler behavior and tantrums. I’m also releasing an e-book on toddler development, so if you are a parent of a toddler, want more toddler information than what I’m talking about in this episode, you have to get those courses.

 

00;02;27;07 – 00;02;40;02

Dr. Mona

It is going to be an incredible resource for you and I can’t wait for you to get your hands on it. So let’s get to the conversation I have with Kate about toddlers and night feeds, sleep associations, and calorie anxiety.

 

00;02;40;05 – 00;02;48;07

Dr. Mona

Oh hey K, thank you so much for joining me on today’s show. So tell me what is on your mind today as a mom?

 

00;02;48;09 – 00;03;11;08

Kate

Hi, doctor. Mona, thank you so much for having me on. I am a huge fan and I’m so excited to be here. I wanted to talk to you because I am kind of struggling with my son, who is 13, almost 14 months old. We weaned him successfully from formula to cow milk, but we’re having trouble taking away the feedings before he goes down for naps and at night.

 

00;03;11;10 – 00;03;16;28

Dr. Mona

Sounds good and so how many total bottle cups of milk do you think he gets in a day?

 

00;03;17;01 – 00;03;38;08

Kate

On a normal weekday, he gets one big bottle before he goes down at night. And then oftentimes times he’ll do one, like early morning feed like 4 or 5 a.m. to go back down. Okay. During the week he’s in full time daycare. He naps there without a bottle. But on the weekends when we have them home, he’ll get another two bottles before his two naps during the day.

 

00;03;38;10 – 00;03;49;19

Dr. Mona

Okay. And so one of the biggest things is understanding is this okay? Like I guess one of your questions is is it okay to still do this? Or do you feel like you want to eliminate it?

 

00;03;49;22 – 00;04;03;07

Kate

I mean, we’ve been told by our pediatrician that we really want to get him away from the bottle within the next couple of months. And especially we want to eliminate the night feeding because, you know, the residue is staying on his teeth. Yes.

 

00;04;03;09 – 00;04;18;03

Dr. Mona

So yeah, my question then would be for the nighttime bottle and also the nap. Are we brushing the teeth after like is there a bottle and then both brushing bad situation and then bed or is it happening right when he goes to bed at night?

 

00;04;18;03 – 00;04;38;01

Kate

The bottle is happening after the bath. But before we do a book, okay, teeth brushing and a song. So the night bottle is not the last thing. On the weekends I try to make it so that the bottle is not the last thing. But to be honest with you, sometimes we’re just running around and I’m like, oh my gosh, we have five minutes before you’re supposed to be asleep.

 

00;04;38;01 – 00;04;44;29

Kate

So it’s like a bottle and then like super abbreviated, like I might rock him and sing him before I put him in the crib.

 

00;04;45;02 – 00;04;48;04

Dr. Mona

So does he wake up in the middle of the night?

 

00;04;48;06 – 00;04;49;01

Kate

Yes.

 

00;04;49;03 – 00;04;50;12

Dr. Mona

What time would you say?

 

00;04;50;14 – 00;05;05;05

Kate

It’s kind of in flux. It used to be, like, very reliably at 430, like almost on the dot. It seems to be shifting a little bit later. So it’s more like 5 a.m. now. And we want him to be sleeping until like 630, 645 in the morning.

 

00;05;05;08 – 00;05;10;26

Dr. Mona

So in order for him to sleep, what happens? He go back down on his own or he needs that bottle to go back down.

 

00;05;10;29 – 00;05;13;12

Kate

He seems to need the bottle to go back down.

 

00;05;13;14 – 00;05;27;05

Dr. Mona

So it sounds like, yeah, we have nighttime, naptime, start of bottles, you know, so obviously start the sleep cycle and then for the morning, like the 430 or 5, we’re needing that bottle to go back down until what time I’ll sleep. Until then.

 

00;05;27;08 – 00;05;29;25

Kate

My goal is to get him to sleep to about 630.

 

00;05;29;28 – 00;05;33;03

Dr. Mona

If you were to give a bottle at 430, what time is he waking up?

 

00;05;33;06 – 00;05;49;28

Kate

So I’m hesitating only because he’s sick right now. He has a double ear infection and he’s also 13 months old. He’s working on his, like, 14th and 15th teeth, so there’s a lot going on. So today he woke up more like six, but he was on a good streak before this latest ear infection of sleeping and tall.

 

00;05;50;02 – 00;06;05;07

Kate

So he would have like the 430 bottle. And then he would sleep until like six 3645 if the bottle was a little bit later there. Sometimes when I was like having to go in and wake him up because he like absolutely needs to be out of bed at seven so that we can get our day started.

 

00;06;05;09 – 00;06;21;04

Dr. Mona

Okay, this is just great information to have. And you are right that listen, with illness and teething, a lot of the stuff we’re going to talk about is kind of when the peak of that is all over. So for example, the first 5 to 7 days of an illness, the strategies I’m talking about, you don’t have to listen to, you can wait till things are better there.

 

00;06;21;10 – 00;06;37;16

Dr. Mona

Same thing with teething like that 1 to 3 days that the tooth is breaking through. Parents often say teething is happening for months, but I’m talking about the peak teething. Like the gums. You know it’s breaking through. You’re seeing irritation. They’re 100%. Then we’re going to give a little pass to all this stuff and just do what you were doing.

 

00;06;37;16 – 00;06;57;14

Dr. Mona

Don’t worry so much about any intervention here. One thing I was wanting to ask, which is what I’m not hearing, is it sounds like maybe in the morning we’re having a little bit of a sleep association that he needs that to go back down. We’ll talk about that in a bit. What about naps? Like if you do give the bottle before a nap, how long are his naps typically because he’s still on a two naps schedule, right?

 

00;06;57;16 – 00;07;16;24

Kate

Yes, he’s still on a two nap schedule. We’re probably needing to change that, like within the next 4 to 6 weeks, I think, because we’re at a point where we are having to wake him up from the naps to ensure that he’s not going to bed at like 9:30 p.m. or something like that. So his two naps are pretty consistent at this point.

 

00;07;16;24 – 00;07;27;21

Kate

They’re at least an hour. I’ve been keeping them by the clock, not by timing, but he’ll usually get in like a 75 minute or a 65 minute nap or two of those on the weekends.

 

00;07;27;23 – 00;07;48;19

Dr. Mona

Okay, that’s actually good, because what I’m trying to understand, and it doesn’t sound like it, it doesn’t sound like he has a really major sleep association with these bottles. It sounds like in the morning there might be one which we’ll talk about, but in general, when I get concerned more so about all this is that if we’re dealing with a child who is having multiple wake up in the middle of the night, and what I mean by that is, remember when we go to sleep cycles, right?

 

00;07;48;19 – 00;08;12;06

Dr. Mona

Including children independent sleep for a child is considered a child who wakes up in between sleep cycles and puts themselves back down, does not need a bottle, does not need someone to rock them. That’s considered independent sleep because I know that he’s waking up in the middle of the night because every human being does. But it sounds like it’s really happening in the morning, which I’m not surprised because the morning the sleep drive is the lowest.

 

00;08;12;12 – 00;08;43;16

Dr. Mona

So right now it may seem that he’s just going to have a harder time going down, and that’s why the bottle is being given. But this is something that we’ll talk about in a bit. But yeah, so I’m not surprised. I’m not super upset about it. Like this is okay. Because if you were telling me that every two hours at 13.5 months or four hours in the middle of the night, right, like from 8 p.m. until, you know, 8 p.m. 11, what are you if we’re having to give bottles like that, then we got to really cut down because nutrition, the child does not need this intake.

 

00;08;43;20 – 00;08;59;29

Dr. Mona

Now going back to your comment about do we need to remove it at all, the fact that you are able to brush his teeth after the bottle, like I would ideally like that situation. Eventually you’re going to get him on a sippy cup or a straw cup, whichever more advanced cup this conversation, we’re not going to talk about that.

 

00;09;00;09 – 00;09;19;12

Dr. Mona

But in that setting, if you’re doing the bottle and then it’s like a bedtime routine and brushing, I’m not as concerned. I’d be more so like, yes, we got to get rid of that if it’s right before sleep. Meaning he falls asleep with that bottle and that’s what he needs, because then that goes back to sleep association. But it doesn’t sound like it is a sleep association.

 

00;09;19;12 – 00;09;39;06

Dr. Mona

So at 13.5 months, it’s not unreasonable. A child still wants milk before they go to bed, and I usually see that by 18 months, two years, you can start asking the child like an A schedule, like after dinner time, hey, do you want milk before bed? And if they say no, yes, you can actually give it that way.

 

00;09;39;11 – 00;09;45;00

Dr. Mona

But you don’t technically need to eliminate the milk. How’s he eating in terms of food?

 

00;09;45;03 – 00;09;48;08

Kate

Not grades, is what I would say. Okay.

 

00;09;48;11 – 00;10;13;17

Dr. Mona

What I would like for you to do is it’s important to kind of have a schedule for you all, like meeting a feeding schedule at 13.5 months, I’d expect breakfast. A lunch and dinner is being offered. I’m not going to get so much into like, how much? Because remember, that doesn’t matter. It’s the offering. And then maybe the milk would be like a a milk between breakfast and lunch and a milk bottle between lunch and dinner or a snack.

 

00;10;13;20 – 00;10;38;20

Dr. Mona

That’s kind of makes sense to me to be a more reasonable schedule than having a milk before naptime, because technically, at this age, a child should not need milk before a nap. It should be like that. They have your breakfast snack lunch, right? So a snack could be milk, or snack could be an actual food snack at this age, ideally by 1516 months I want it to be like a food meal rather than milk.

 

00;10;38;26 – 00;11;07;24

Dr. Mona

So breakfast, lunch, dinner. And then they, you know, you have your two naps in between there. And then when they wake up from their afternoon nap, they can have milk or snack and then they have dinner. So we first want to set the schedule as such so that we have a routine. And then that does mean then yes, you would want to eliminate those milk feeds before nap time, but the milk before bedtime I’m okay remaining because I don’t that you’re brushing the teeth after those bottles in the daytime correct?

 

00;11;07;24 – 00;11;30;03

Dr. Mona

Yeah, right. To me, if we’re going to eliminate anything, we need to eliminate the milk feeds that are happening before naps, because that, to me, is more of a priority than eliminating the bottles that are happening before bedtime. Because that one is reasonable. First thing, when they wake up in the morning, or the first thing they do before they go to bed, it’s reasonable for them to want milk, as long as it’s not that they need that multiple times throughout the night.

 

00;11;30;05 – 00;11;52;27

Dr. Mona

I’m okay with it. They’re going to wean themselves off of that. But I think because you’re dealing with food issues during the day and because just from developmental reasons, they don’t need the milk before the nap, I think we have to create that schedule of breakfast, snack, lunch, and then wake up from a nap. So if you’re on a two nap, schedule an example would be technically been one of those bottles.

 

00;11;52;27 – 00;12;07;29

Dr. Mona

Could be like right before, but it would be like you do breakfast. He can wake up and if he wants a milk bottle when he wakes up, that’s fine before breakfast. But ideally we’re going to do breakfast. And then usually if you’re on a two nap schedule, that first nap is happening around like 10 a.m. or what time.

 

00;12;08;02 – 00;12;09;19

Kate

1030, like 930 10:00.

 

00;12;09;19 – 00;12;27;09

Dr. Mona

Yes. Okay. What you could do then is that time can have a milk bottle, not because you’re doing it for his sleep, but that’s because it’s the schedule, right? You do like thinking of that as like a morning snack. So you do that 930 bottle, 10:00 going to sleep. I would try to keep the half an hour so that you were not creating that sleep association.

 

00;12;27;15 – 00;12;41;12

Dr. Mona

And then he would have the bottle. He would take the nap when he wakes up, you know, he plays. It’s going to be then closer to lunchtime and then we’re going to do lunch. And then he’ll probably then take another nap around like 130 or 2.

 

00;12;41;14 – 00;12;42;00

Kate

Yes.

 

00;12;42;00 – 00;12;57;25

Dr. Mona

Yes. Okay. And so then that’s going to be nap time without a bottle. Right. Because schedule wise you’re not right. And then when he wakes up you can give him a bottle and then he’ll have dinner later. So it’s kind of creating the schedule not based on his sleep needs, but based on like kind of spacing out the timing.

 

00;12;57;29 – 00;13;13;19

Dr. Mona

And it may recall that the first one is happening right before he goes down for a nap. And that’s reasonable. But I’m not worried that if you continue doing that, that create a sleep association or anything like that. Now for finding that he keeps waking up and needing the milk bottle to go down, then we have to eliminate that.

 

00;13;13;19 – 00;13;32;26

Dr. Mona

But I would first kind of create your schedule. Look at it that way, see if you can maybe move the milk to be especially for that afternoon one, rather than it being right before the nap because lunch was just offered. Had it be that he wakes up and he can, you can offer him the milk bottle when he wakes up as like a quote unquote afternoon snack, if you will.

 

00;13;33;01 – 00;13;51;21

Dr. Mona

And then eventually I would like you to offer, like transition in those afternoon and morning milk bottles, the ones that are happening at nine, 30, ten, and the ones that happens in the afternoon, transitioning those to actual snacks like sitting down with a snack, like a yogurt or whatever else that’s not coming through a liquid form.

 

00;13;52;14 – 00;13;53;15

Kate

It makes a lot of sense.

 

00;13;53;15 – 00;14;29;05

Dr. Mona

Because that’s going to give you more opportunity then, because for exposure to foods, right? Like after they turn one, I want us to move away from milk being the ultimate source of nutrition, because after they turn one, they are exploring other foods. So I’m okay if you keep it as such. But I would start to kind of in your radar when he’s feeling better from his illness and his teething, to start to really focus on maybe one of those being now a snack time like so don’t eliminate all the bottles, but maybe the morning snack, quote unquote, the one at nine 3010 is going to be a snack instead of a bottle, so that we

 

00;14;29;05 – 00;14;47;02

Dr. Mona

can start to transition there. But the goal is definitely by 16 months, I’d expect that he’s going to be on the three meals and two snacks, or definitely by 18 months for sure. Okay. Yeah. And then I want to talk about the morning. The fact that he wakes up, is that a good place to kind of continue?

 

00;14;47;05 – 00;14;48;22

Kate

Yes I would love some thoughts on that.

 

00;14;48;23 – 00;15;08;15

Dr. Mona

Okay. Just to summarize, we already talked about the fact that, okay, I don’t think this is a major sleep association, but looking at your schedule, seeing ways that we can kind of make it that in our brain we’re trying to really not rely on, he needs the milk to go down. I get what you’re saying, that he has had that pattern, but almost like here’s the time schedule, almost like how we would do a meal schedule.

 

00;15;08;18 – 00;15;24;13

Dr. Mona

And I think this is going to be helpful so that you’re leaning in on making sure that meals are being offered in a seated position to encourage the, you know, introduction of solids and advancements of solids. And then the milk is there because it’s part of the schedule, not because he didn’t eat his lunch, not because he didn’t eat.

 

00;15;24;13 – 00;15;48;10

Dr. Mona

It’s breakfast. I don’t fall into that at all. Like, I don’t want it to be that he didn’t eat his breakfast. So you’re like, well, let’s just give him a bottle because then that is absolutely reinforcing at this age that you don’t need to eat here. I’ll just give you a bottle right away. But as long as you’re not doing that and it’s a schedule like, okay, eat breakfast, he ate ten bites or he ate 40 bites grain and then the bottle is going to come when the bottle is supposed to come, which is going to be 930.

 

00;15;48;13 – 00;16;06;01

Dr. Mona

That’s how we kind of create that schedule for them. And then again, you’re deciding when and what he’s eating, drinking in this example, and then he’s deciding if and how much of anything he’s going to take. So he could eat a big breakfast. He could drink just only a little sip of the milk at 930 or 10 whenever you decide.

 

00;16;06;06 – 00;16;11;05

Dr. Mona

But that’s kind of how I would create the schedule for yourself. And then we can talk about this morning situation.

 

00;16;11;09 – 00;16;30;01

Kate

Okay. You totally tapped into like part of it with the bottles is my anxiety around like, oh, he didn’t eat very much. He barely had anything for lunch. I want to put him down. I want him to get a good nap. Let me give him these calories so that he can sleep. I have a really hard time. Yeah, I guess trusting that he’s eating enough.

 

00;16;30;03 – 00;16;46;27

Dr. Mona

And so this is a sticky situation because your anxiety makes sense. I get it that you have that because of course, as parents we want the best for our children and we want to make sure that they’re nourished. But the problem with adding more milk into this picture, like volume wise or, you know, we’re not giving him an opportunity and then that can lead to food restriction, right?

 

00;16;46;27 – 00;17;09;05

Dr. Mona

Because we think, oh, he didn’t eat. So let me just replace those calories with milk. That is why I love the schedule, because in a way you’re telling your brain there is a schedule coming. So you give a meal at 730. In your perception, he ate not a lot. Okay, so then now if you give him milk at 830, we have now kind of associated at this age that okay, well you don’t need to do what you’re doing here.

 

00;17;09;12 – 00;17;24;09

Dr. Mona

The milk is going to come when it’s going to come. You could just fill your belly with that, that it’s such a slippery slope of using a toddler’s cues in feeding versus, you know, in terms of like, okay, well, you didn’t eat, so I’m going to do this. We want to create the schedule so that there are opportunities.

 

00;17;24;09 – 00;17;43;03

Dr. Mona

You are obviously offering a breakfast. You’re going to offer that bottle. There is opportunity for him to decide what he’s doing at all parts throughout the day. But it’s not leading into this. Well, he didn’t do this, so let me give it sooner. Right? Let me cater to this because in that that leads to more selective eating because they know well, I don’t want to eat this egg.

 

00;17;43;04 – 00;17;56;27

Dr. Mona

I don’t want to work hard for it. It’s not something I want to do. I’m giving like, obviously you’re going to diversify the meals, but then they just will wait it out and drink what’s easy, right. Which is the milk. So milk should never be a meal replacement. It should never be that oh he didn’t eat. So I’m going to give him extra milk.

 

00;17;57;04 – 00;18;01;29

Dr. Mona

Like right now you offer the milk with the intention that it’s time to offer the milk, if that makes sense.

 

00;18;02;00 – 00;18;07;02

Kate

Okay. Yeah. No. Totally. Does. Just having a B schedule based instead of yeah.

 

00;18;07;07 – 00;18;20;18

Dr. Mona

This is part of our routine. And then going back to your calorie anxiety, I get it. Especially because he’s not eating. That’s why I want you to really offer the variety of the foods on a schedule, really being patient with him. And is he self-feeding at all yet?

 

00;18;20;21 – 00;18;23;18

Kate

Yeah. Okay. Good stuff. It’s what he likes to eat.

 

00;18;23;21 – 00;18;43;03

Dr. Mona

Right? So the thing is preferences are there and it’s picky eating. Selective eating starts very early like ten months. You know we see that they’re preferential. Introduce the variety offer the seafood obvious is not the conversation about picky eating. But when you have that schedule that is in my brain a way that gives you anxiety, control and security that I am offering my child stuff.

 

00;18;43;06 – 00;19;02;10

Dr. Mona

I have to trust my child that he will eat based on his cues. Obviously, if there’s things like gagging that persists, if he’s only eating one food group or not eating any like completely avoiding every single vegetable for periods on end, you know, speak to your clinician. We talk about that, but we do want to trust them and their intake.

 

00;19;02;11 – 00;19;24;29

Dr. Mona

And just another common is around the age of 11 months, 12 months we can see intake decrease. So with food, with milk, but definitely with food that your baby who may have been feeding and eating a lot more could drop in their intake because this has to do with just their caloric needs in general. So to avoid this calorie anxiety and this sort of like I don’t trust it.

 

00;19;24;29 – 00;19;43;10

Dr. Mona

Like what’s going to happen? Keep the schedule and then also make sure that you are offering the variety at meal, at snack. And then your reassurance is going to be those checkups, right? With the doctor. You’ll go for a visit. You’ll see their weight waking if you’re feeling like in between visits, there’s poor weekend. You can always go in just to get away.

 

00;19;43;11 – 00;19;58;09

Dr. Mona

Check and talk to the clinician, but you are going to have that schedule be your best friend in terms of providing you the reassurance that I am offering my child this food and he or she is going to decide what he does with it. But another thing is coming on is set to come at the time.

 

00;19;58;11 – 00;20;00;09

Kate

Okay. Yeah, makes a lot of sense.

 

00;20;00;09 – 00;20;19;19

Dr. Mona

And then the morning. So in the morning at 430, he has created an association that in order to stretch myself a little longer, I’m going to hold myself over with this bottle. Is it the end of the world? No. Do I love it? No, because I know they don’t need the calories at that time, especially after the age of one.

 

00;20;19;21 – 00;20;36;20

Dr. Mona

A child does not need to be fed in the middle of the night. People can say, I saw my kid needs it, but they do it because it’s there and they will drink the whole thing because it’s there right? But they don’t need it for calorie intake at all. So what we want to consider here is you can continue doing it and see if he wins it off.

 

00;20;36;20 – 00;21;01;14

Dr. Mona

Definitely don’t rock the boat right now with the illness and the teething, but then it becomes weaning off of it, and the weaning off of it is almost like a sleep training that you would do had it been like an infant. Like if you’re going to be weaning off of feed as an infant. So at this age, the options would be at that time you have a cold turkey option, which you just eliminate that bottle and we’ll go into that or you have a I’m going to wean it off.

 

00;21;01;16 – 00;21;21;09

Dr. Mona

So with the weaning off option, it’s a normally a four ounce bottle, you would only allow two ounces. And so he would get the little bit that he likes. It’ll be the comfort that he’s used to. Right. He’ll drink the two ounces if he asks for more or like points to the bottle or says like whatever signs, whatever communication that is it, right?

 

00;21;21;09 – 00;21;37;13

Dr. Mona

We are trying to reassure him that you got the two ounces. So then it may mean that you lean in on some sleep training methods, which we’ll discuss. So you have your weaning option two ounces for 4 or 5 days. Once he’s doing that, you can go to one ounce and then off completely because you’re weaning him off of that.

 

00;21;37;15 – 00;21;53;18

Dr. Mona

Now, if he does get upset, if he does cry, if he’s waiting for that in both methods, whether you did cold turkey or whether you’re doing it like a weaning method, then you approach it like sleep training. Did you just any sleep training or did he kind of start sleeping on his own independently?

 

00;21;53;20 – 00;22;01;15

Kate

We did sort of a modified Ferber, but we really leaned just as heavily as possible on sleep hygiene, and he did a lot of it himself.

 

00;22;01;18 – 00;22;15;28

Dr. Mona

So leaning on that again is what you’re going to do if you end up doing more of a training. I have a whole other podcast episode about toddler and sleep, but you basically going to lean in on consistency. So is it going to be that you’re going to stick to the weaning of the bottle and then that’s it?

 

00;22;15;28 – 00;22;39;14

Dr. Mona

Or am I going to do cold turkey? And when he does wake up, am I going to do a modified Ferber example? Am I going to check in with him, reassure him and then leave? Am I going to pat his back? So deciding what it is that you want to do with those moments? Understanding, like I said already, that those early mornings, the reason why it’s happening is the sleep drive is much less right.

 

00;22;39;14 – 00;22;55;09

Dr. Mona

So we’re way more lighter sleepers in the morning. So he’s waking up and we want to try to give him an opportunity of not needing the milk. Right. Because in our brain he wakes up and you’re like, okay, well, if I give the milk, it’s going to hold him over. But now we’re trying to teach him that you’re up.

 

00;22;55;11 – 00;23;15;12

Dr. Mona

We don’t need to give you the milk. It’s like eliminating this only few hours sleep association he’s created, but he doesn’t need it for nutritional value. He’s going to do it because it’s there. And so it is leaning in on the sleep hygiene. It’s leaning in on, okay, if that’s not working, doing a modified Ferber, which would mean when you hear him wake up, give him five, ten minutes.

 

00;23;15;12 – 00;23;34;18

Dr. Mona

If he’s still crying, you go in there, you talk to him. But we’re not offering the bottle. We’re offering us as like face to face in situations where you’re feeling like me going in makes him more mad then you and your family. Again, I like to talk about options. Discuss. Am I going to just do a complete see how long he cries situation?

 

00;23;34;18 – 00;23;55;22

Dr. Mona

But that’s why I like to give you decide what method works for you to approach wake ups at that moment without a bottle. Like, am I going to go in? Am I going to pat his back? Am I going to be in the room with him until he falls asleep? And then I leave the room, like deciding what works for you and your family for those morning wake ups, but eliminating those bottles while it happens.

 

00;23;55;24 – 00;23;57;18

Kate

Yeah, that makes a lot of sense.

 

00;23;57;20 – 00;24;13;03

Dr. Mona

And it’s up to you because you may end up deciding that, no, I only want to wean it off because again, with the feeling of calories, like you said, I totally respect that. I know he’s not going to wither away. I can tell you already that children, especially even younger children, but he will get the calories he needs in the daytime.

 

00;24;13;03 – 00;24;28;00

Dr. Mona

Like when he’s awake. He will regulate what he needs, but also these nighttime feedings could be also. Why? I know it sounds a little silly, but it is four ounces. Like it could be. Why he may not eat as much in the day right like that. He’s getting fed at night. So we want to make sure that we’re kind of eliminating that.

 

00;24;28;05 – 00;24;43;04

Dr. Mona

But the strategy would work either way because I can guarantee that you go down to two ounces and he falls asleep right away. So what do you do if he, like, gets a two ounces and he’s still awake like I said, you would approach it as you would any nighttime waking your family feels how you want to approach.

 

00;24;43;07 – 00;24;45;28

Kate

Yeah. Makes sense to go out and do it with a plan.

 

00;24;46;00 – 00;25;02;04

Dr. Mona

Yeah, sure. So the plan has to be consistent. The plan has to be when he’s feeling better. I understand completely that he’s not feeling well right now. So do what you need to do to survive the next week. Let’s say a week after week. I’m gonna be honest, it’s not teething anymore. It’s just now his new habit. Okay, like we blame teething for a lot of teething.

 

00;25;02;04 – 00;25;20;13

Dr. Mona

If we keep saying everything’s teething, it’s going to be pretty much for two and a half years. So yes, the peak time that they’re dealing with the issues 100%. But then we go back to, okay, your teeth are out. I saw the gums like the teeth have broken through. So once they’ve broken through then we say, okay, time to now approach this with a consistent plan.

 

00;25;20;13 – 00;25;38;05

Dr. Mona

Are we going to wean down? You could do 3 to 1oz if you want to go slower. Or are we going to do a cold turkey method. And I am not telling you which one to do because it just depends on your family’s feeling. Did your clinician or pediatrician say to eliminate it completely, or what did they say to you for that morning?

 

00;25;38;05 – 00;25;41;26

Kate

One yes, they want us to eliminate it completely.

 

00;25;41;26 – 00;26;02;05

Dr. Mona

I figured that’s usually what it would be because we know that they nutritionally don’t need it. Even if they take it, it becomes a habitual thing. Like almost like me and you waking up in the middle of the night and going down to the refrigerator to get a glass of milk. Right. You didn’t need that. You would have been just fine if you never got that glass of milk, but you drank it because it was there.

 

00;26;02;07 – 00;26;18;17

Dr. Mona

So that’s what’s happening in these older children. Under six months is a whole different story. Like under six months. There is needs, you know, the kid may need it or whatnot, but after one year after and including after six months, the nighttime feedings become more habitual than they actually are. Necessity.

 

00;26;18;19 – 00;26;31;08

Kate

Yeah, it’s so hard because I understand that, like, intellectually. But when it’s 4 a.m. and he’s crying and I know he will go back down so easily with a bottle, and I’m tired too, right? It’s just hard to kind of like, hold the line.

 

00;26;31;10 – 00;27;01;16

Dr. Mona

And honestly, just to be completely transparent, you could do what you’re doing for another month and see if he regulates himself. We sometimes feel like, oh, I have to eliminate it. You could give it another few weeks to see. Okay, maybe he’ll eliminate it and not wake up. But if it is just a cycle, in my opinion, if this is something that continues until he’s, you know, 14 months for sure, let’s say 2 to 3 weeks from now, I would be more on the side of agreeing with your clinician that, hey, this is a time that we need to remove the association, right?

 

00;27;01;16 – 00;27;22;27

Dr. Mona

We need to not provide it or we provide less. Like I said, I’m giving options because I can hear from you. And I’ve been there where completely cold turkey may not feel right to you, even though I know it’s okay from a medical standpoint and a developmental standpoint. That’s why I give you the weaning option. But whatever you end up deciding, remember that if you decide to do the weaning, we want to be consistent on the reduction.

 

00;27;22;27 – 00;27;43;13

Dr. Mona

So for example, if you’re going like two ounces and then one ounce and then off, we don’t want to like night number six, you’re like, well let me just give four ounces again. Right. You want to be very methodical with your weaning or if you’re choosing the more, cold turkey and I’m just going to intervene with a Ferber type method or what not to remind him about independent sleep, because that’s what you’re doing, right?

 

00;27;43;13 – 00;28;06;15

Dr. Mona

You’re reminding him in those early wake hours, well, when he is waking up that the sleep drives low, that you can go back down, you’re going to be okay. So whenever I talk about sleep training in general, I always say from 7 p.m. to 7 a.m. or pick a 10 to 12 hour time frame, you’re going to approach any wake ups, whether it’s at 1:00 am or at 5 a.m., how you would with any wake up that happened during the night.

 

00;28;06;15 – 00;28;17;00

Dr. Mona

Like that’s kind of how you would approach. But the method is up to you or if you even do that. All right. So training is not a requirement. But this is kind of how we’ll teach him that we don’t need the association anymore.

 

00;28;17;03 – 00;28;43;14

Kate

Yeah. Since he was almost a newborn it has been like 430 in the morning. I do think he will need some help to break the association. I did say I mean it like it’s snuck up closer to 5 a.m. instead of 430 recently. Like that seems to be changing my question. Maybe this is like too technical, but he has had chronic ear infections like so we’re going to see an end to next month to talk about getting tubes.

 

00;28;43;17 – 00;29;11;12

Kate

He’s had five year infections in the past five months. So just for my own preparation, my question is if we start to do the weaning like you said. So we’re cutting down to two ounces for 3 or 4 nights and then he gets sick again. The goal is not to add more milk or another feed, right? You can just like hold steady with whatever reduced amount and then get through the week or the peak of that illness or that teething, and then after that start to reduce again.

 

00;29;11;14 – 00;29;12;18

Kate

That makes sense.

 

00;29;12;21 – 00;29;19;03

Dr. Mona

Yes. Meaning you’re saying like if he gets sick, what do we do about intake weaning? Do I go back to offering at night.

 

00;29;19;05 – 00;29;34;29

Kate

Yeah. Or I guess I’m asking like if he gets sick again and it’s in the middle of when I had planned to do reductions. Right. So let’s say like I’m giving a four ounce bottle and then I cut down to a two ounce bottle and I say, okay, I’m going to do a two ounce bottle for the next three nights.

 

00;29;34;29 – 00;29;42;09

Kate

And then boom, he’s got an ear infection. And his towel for an ear infection is he’s waking up like in pain every two hours.

 

00;29;42;09 – 00;29;44;29

Dr. Mona

I would start where you left off. Don’t go back up.

 

00;29;45;01 – 00;29;45;19

Kate

Okay.

 

00;29;45;22 – 00;29;59;21

Dr. Mona

If you do the weaning option. And the reason I’m saying that is because I know he doesn’t need it. Does that make sense? Like, I know you’re doing the weaning because for us, more so than him. So I don’t want us to go back and start all over. I would start with whatever you left off. So just say you left off at two ounces.

 

00;29;59;21 – 00;30;17;04

Dr. Mona

And he was doing great. But what I want to also encourage is that when he’s sick, I don’t want us to fall back into the trap that you feel he needs night feeds, because that’s part of the anxiety, right? You can give him water if you feel he’s dehydrated. You can absolutely give water if he wakes up and needs it and he’s ill and he needs it.

 

00;30;17;04 – 00;30;31;16

Dr. Mona

But our goal is to move away from the milk feeds at middle of the night being, let’s say, 7 p.m. to 7 a.m. so even if he were just he gets sick and you’re like, well, he’s up. I need to give him milk because he didn’t eat in the daytime. I don’t want that to be the case because that’s not teaching him.

 

00;30;31;18 – 00;30;47;28

Dr. Mona

And the pattern of we eat during the day. And of course, if you want to give water, I’m fine with water. But then, you know, also, we don’t want to create future sleep associations with water. The water is only because he’s sick. Yeah, the water is not going to be like when he’s all better. I don’t want him waking up at 4 a.m. for water either, right?

 

00;30;47;28 – 00;31;03;19

Dr. Mona

Because you don’t need that. Like you can wait till seven and or whenever it’s time to get up. This is I don’t want us to fall into that pattern because of our anxiety and worry, because yes, you can say to yourself, well, he’s not getting enough. Like, I have to give him the milk. We’re going to focus on the daytime.

 

00;31;03;25 – 00;31;12;20

Dr. Mona

Remember, he’s getting so much during the day. That is where we do all of our eating and our drinking now at this age. So that is what we’re trying to lean in on and teach him to do.

 

00;31;12;23 – 00;31;23;02

Kate

Yeah. Makes sense. Yeah, I have definitely like when he’s been sick, given him if he wakes up and it’s not a time that he would usually feed, I’m just giving him like plain water in a bottle.

 

00;31;23;03 – 00;31;40;10

Dr. Mona

And that’s reasonable. Yep. And that’s fine. Right now when they’re sick. Right. Because you’re already tired. You know, maybe they have a fever. They’re not feeling good. I’m totally fine with that. But then remember, when he’s all better with all this is over, we are going back to. There is nothing that he needs, liquids wise, milk or otherwise, in the middle of the night.

 

00;31;40;10 – 00;31;59;08

Dr. Mona

What? He’s better like when he’s all okay with this. Like acute issues of teething and illness. That’s what we’re trying to lean in on so that we’re not creating any association with needing anything in the sleeping hours because he doesn’t need it for calorie like, I’m happy a clinician said this to. I know that if you eliminate all those night feedings, he’s still going to grow on his own trajectory.

 

00;31;59;11 – 00;32;12;12

Dr. Mona

This four ounces that he’s getting at four in the morning is not the reason why he’s gaining weight, I can tell you that much. It’s the daytime. And I agree with your clinician that we want to lean in on the meals and the daytime being where all the work is done, and that’s going to happen for you.

 

00;32;12;14 – 00;32;29;01

Kate

Yeah. Thanks. That’s funny. Like when you say it like that. Like, do I really believe that the four ounces that he’s getting at 430 in the morning is what it’s like making or breaking his diet? No, of course it’s. Yeah, but it’s what helps him get back to bed and selfishly, it’s what helps get me back to bed.

 

00;32;29;03 – 00;32;32;17

Kate

I don’t really want to be awake at 430 in the morning either. Yeah.

 

00;32;32;19 – 00;32;46;13

Dr. Mona

And I will say it’s short term. It’s deciding if we want to continue that. But it’s also if we eliminate it, it’s short term activity to get long term gains. Right. Like my son was an early week or two and we we did a Ferber method. He would wake up at five. I forbid him from 5 to 7.

 

00;32;46;16 – 00;33;02;18

Dr. Mona

So that meant that sometimes he cried for ten minutes. 15 and now he sleeps until eight, right? If I had never done that, if I had just let him wake up at five and never Ferber ised him until seven, he would have been this early waker because he was waking up multiple times, 2 or 3 times between 5 and 7.

 

00;33;02;18 – 00;33;19;24

Dr. Mona

So again, it’s part of the training process. Some people are like, I can’t handle it, it’s going to be longer. But I looked at it as like, okay, if I do this for 1 to 2 weeks, then he’s going to understand the rhythm. Yeah. And if it doesn’t work, you go back. Remember, nothing is permanent. So just say you try doing a modified Ferber with him for a week.

 

00;33;19;24 – 00;33;33;11

Dr. Mona

At least try things for a week if you hate it and you’re like, it’s not working for us. Nothing is ever set in stone. As parents, we can always move back. You can always say, you know what? Let’s go back to what we’re doing. Maybe we’ll try again later. Maybe we’ll do another strategy and then that’s how that goes.

 

00;33;33;11 – 00;33;38;27

Dr. Mona

So don’t ever feel like it has to be this and it’s over, right? Like there’s always flexibility and pivoting. That can happen.

 

00;33;39;00 – 00;33;44;17

Kate

Yeah. That is so healthy and important to remember that everything is just kind of an experiment. Right. But it.

 

00;33;44;17 – 00;34;10;07

Dr. Mona

Is. And that’s why it’s hard. It’s like installation. Parenting is nuance, and so much of it is why I like having these conversations on the podcast is I’m shooting with you. I can’t tell you what you’re going to end up doing because that’s not my job. My job is to say, here’s what your options are. You need to think about as a parent what you want to do now, of course, I record these episodes with you all knowing that there’s a lot of different types of people listening to understand options, right?

 

00;34;10;07 – 00;34;25;07

Dr. Mona

But now you have your options and you’re going to save yourself and go home and talk to your partner and say, what do you want to do with this? Do you want to do a slow wean? Do you want to do cold turkey? And that is how we make the decisions, you know, and my job is to provide the options and you all can decide how to implement and be consistent.

 

00;34;25;07 – 00;34;32;05

Kate

I agree. Yeah. Thank you for that. It’s really helpful.

 

00;34;32;08 – 00;34;52;07

Dr. Mona

Thank you for tuning in for this episode. As always, if you liked what you heard, make sure you leave a review rating and share the episode and tag me on social media. And if you have a toddler, make sure you check out my courses for toddler development behavior, tantrums, picky eating, potty training, as well as my infant courses.

 

00;34;52;07 – 00;34;56;23

Dr. Mona

If you are still in that first year, thank you for joining me and I’ll chat with you all next time.