1 Is your baby under 4 months old?

2 Does your baby cry excessively in the evenings, making it difficult for you to settle him or her for sleep?

3 Does your baby often wake in the night but go back to sleep once fed?

4 Does your baby seem to sleep less than other babies of the same age?

5 Does your baby sleep a lot during the daytime and less at night?

6 Has your baby always followed this sleeping pattern?

7 Is your baby used to having daytime naps?

8 Does your baby sleep in the same room as you?

9 Is your baby waking repeatedly at night after previously sleeping well?

10 Does your baby seem unwell in any way?

11 Could your baby be waking because he or she is hungry?

12 Could your baby be too cold or hot during the night?

13 Has there been any recent domestic upheaval or possible cause of anxiety?

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Possible causes There are many reasons why your baby may be crying excessively.

go to Excessive crying

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Possible cause Hunger is probably causing your baby to wake. The need for frequent feeds is normal in babies of this age.

Action Attempts to prevent a young baby from waking at night through hunger - for example, by offering supplementary bottles of milk in the evening - are usually unsuccessful. Never add extra formula to your baby's milk. Try to take rests during the day when your baby is asleep. If your baby is breast-fed, try expressing milk so that your partner can sometimes give the baby a bottle at night. If you think that lack of sleep is affecting your general health or is making you resentful of your baby, consult your doctor or nurse.

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Possible cause and action Some babies naturally need less sleep than others. Try to keep your baby entertained when he or she is awake by providing plenty of things to look at and toys to play with. Also follow self-help measures for helping your baby to sleep (see Helping young babies to sleep, or Helping older babies to sleep).

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Possible cause and action Younger babies will sleep at any time of day. After the age of 2-3 months, your baby should be encouraged to sleep more at night by establishing a clear difference between day and night. To do this, keep curtains open during the day and avoid having bright lights on in the baby's room at night. If you feed or change your baby at night, keep the light dim or use a night-light, and try to avoid chatting to or playing with the baby.

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Possible cause and action As your baby grows older, he or she will need less sleep. Try to reduce the length or number of naps in the day so that your baby sleeps better at night.

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Possible causes You may find that sharing a room with your baby results in disturbed nights for both you and your baby. The problem may be that you make sounds that disturb your baby. However, it is more likely that you will be overaware of your baby's movements during sleep and may think that the little noises that babies often make in their sleep are signs of wakefulness. Many babies are restless sleepers and, if left undisturbed, will continue to sleep.

Action If possible, move your baby into a different room. It is unlikely that you would fail to hear a true cry, but you are not so likely to be disturbed by less urgent sounds.

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Possible causes and action If your baby has specific symptoms, such as fever, diarrhoea, or vomiting, consult the relevant chart in this content. If there are no specific symptoms but your baby continues to seem unwell, you should contact your doctor or nurse.

21

Possible cause and action As your baby grows, he or she will need more food. Increasing feeds in the evening may stop your baby waking at night. Alternatively, you may need to start introducing solids to your baby if you have not already done so. Consult your doctor or nurse for advice.

22

Possible cause Being too hot or cold may be causing your baby to wake in the night.

Action Try to keep the temperature in your baby's room at about 18°C (65°F). Your baby should need no more covers than you would in similar circumstances. Letting your baby get too hot may increase the risk of sudden infant death syndrome, or SIDS. If your baby kicks off the bedclothes and gets cold, try dressing him or her in a sleep suit at night.

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Possible cause Babies sense anxiety or stress in their parents and can be disturbed by it.

Action It may take some time to reassure your baby. If you can, try to keep your baby's routine as stable as possible, even if your own life is unsettled. When your baby wakes at night, offer a drink and a cuddle, but make sure that your baby understands that he or she will be put back in the cot; otherwise, there is a danger that the baby will get into the habit of waking during the night and expecting to play (see Helping older babies to sleep.

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Possible cause and action A need for the reassurance of your presence is the most common explanation for waking at night when a baby is past the stage of needing night feeds. Try to stick to a bedtime routine (see Helping older babies to sleep).

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Consult your doctor if you are unable to make a diagnosis from this chart.