Q. Could you please offer some advice for my niece's first baby who is 4 months old, breast fed and is gaining weight well but just doesn't sleep? He sleeps for a 2-hour period overnight and a maximum of 30 minutes two times during the day. She has seen his primary care provider and gone for an evaluation for his colic and no medical problems found. She is getting frustrated and a lot of incorrect advice from extended family (i.e. start cereal, etc).
-- via e-mail

A. When is the baby put to bed, where and with whom? At this age, an infant is ready for a consistent schedule for meals, naps, bedtime and other activities. It will be easier for him to get himself ready for a new activity, and to let go of the last one, if the cues for these are familiar, predictable.

He's more likely to fall asleep if he's usually put to sleep in the same place, at the same time, with a regular routine of relaxing rituals leading up to quiet time and bed time. Many, if not all, babies who have trouble sleeping are hyperalert and hypersensitive, so parents will want to avoid overdoing their ministrations. A dark, quiet room for sleeping. No TV. As little stimulation by other siblings and by those around him as the time for him to sleep begins to approach. Blackout curtains can help if he's sensitive to light, and his parents might try a "white noise" machine, or a CD of monotonous lullabies.

What does he do when he doesn't fall asleep? And what do those around him do then? What goes on during the night when he's awake? At naptime and bedtime, activity and stimulation should be at a minimum -- even if he doesn't seem ready or able to sleep.

A quiet, repetitive story or song, but not a lot of jiggling, bouncing and dancing, at these times, will help him get the message. When he can't sleep, and cries out when left alone, parents can go to him to sit next to him. They can gently pat his back and croon to him. But don't do too much -- it will keep him awake, and teach him to keep himself awake so he can get more.

Some babies continue to wake up repeatedly during the night in order to feed even when they don't require more food. Instead, they have grown accustomed to the comfort of sucking. This is often the case for babies who feed only briefly and take in very little during their middle of the night nursings, or whose diapers are repeatedly drenched throughout the night.

These infants can eventually be taught to substitute their own thumbs to suck to settle themselves. First, though, the feedings can be spaced out, and the amount given can be decreased, so that the infant can gradually grow accustomed to sleeping longer between feedings, and be less reliant on getting filled up again to get back to sleep. A mother who is breastfeeding a baby who has trouble sleeping will also want to cut back on coffee, tea and sodas containing caffeine.

When he is asleep, what is he like? Does he appear comfortable and tranquil? Does he seem to have trouble breathing? Any trouble breathing or other discomfort is bound to keep a baby awake.

What is he like when he's awake? Does he spend long periods of time crying? You mention colic -- a term for a baby who cries more than 3 hours a day for more than 3 days a week without an identifiable medical cause. This should resolve by 3 or 4 months of age, so we urge that parents ask for another search for possible causes when this long-lasting crying persists beyond this age.

Among the many other possible causes for excessive crying is a history of being born small for gestational age. Was he long and lean? Did he look worried as a newborn? For reasons we often can't explain, these babies are deprived of nutrients in utero. Then they are born below an expected ratio of weight to length (called Ponderal Index.) Even if they are as much as 7 pounds at birth, the placenta may have been small and not entirely adequate. This often leads to a fussy, fussy baby (more than the expectable 2 or 3 hours at the end of each day). The fussing every day can last 4 or 5 months in these babies, despite their gaining and growing well otherwise.

As your niece sorts out the sleeplessness and colic with her pediatrician, we hope you are able to rally as much support as you possibly can for her. The whole family will need as much backup as they can get!

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is director of Special Initiatives at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

c.2008 T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.