Sleep training is important for both babies and parents. It is an effective way to establish healthy sleep habits and ensure you are practicing safe sleep. Unfortunately, it's not uncommon for babies to experience challenges during the process. One such challenge is when babies vomit during sleep training. Although it can be scary and distressing for parents, understanding the reasons behind this occurrence and learning how to handle it can help navigate this phase with greater confidence and reassurance.

Why do babies vomit during sleep training?

Babies may vomit during sleep training due to a variety of reasons. Here are some common factors that contribute to this occurrence:

Crying and agitation:
The first thing to remember, is that a baby's main form of communication is crying, so when you are making changes to their sleep habits and routine, it will initially cause confusion. The baby will cry to express their confusion in this situation. When a baby cries longer or more intensely than normal, they produce more mucus and become congested. This can lead to gagging which can then lead to vomiting. Another factor that can contribute to vomiting, is when babies cry excessively, they may swallow air, which can cause them to regurgitate partially digested milk or formula.

Using a sleep training method that doesn't fit well with the baby:
Sleep training isn't a one size fits all. You need to take into account your baby's age, personality and temperament. Often times, vomiting will happen with a baby who is left to cry it out for too long. Remember that true Cry It Out is saying goodnight, placing baby in the crib, leaving the room and not returning to the room until morning, so some babies will cry a lot more with this method for the first night or two. While the cry it out method is a safe and effective way to sleep train, it may be too much for some babies to suddenly be put in their crib and left alone. They may need a more gentle sleep training method.

Reflux or gastroesophageal reflux disease (GERD):
Babies with reflux may have a higher likelihood of vomiting during sleep training. Reflux occurs when stomach acid flows back into the esophagus, causing discomfort and potential regurgitation.

Overfeeding or rapid feeding:
If a baby is fed too much or too quickly, their stomach may become overfilled, increasing the chances of vomiting. This is more likely to happen during sleep training, as babies may have a heightened stress response.

Feeding too close to bedtime:
If you are feeding your baby right before laying them down to sleep, they do not have time to digest that feed, so when they get upset and cry they are more prone to vomiting up what they haven't digested yet.

Behavioural:
It may be hard to believe, but some babies, especially toddlers, can vomit at will. The reason is because they have figured out that vomiting means their parent will come back, clean them up, give them cuddles and attention, and in some cases the parent helps the baby or toddler to go to sleep. This is one reason it is important to be mindful in how you respond if your baby vomits during sleep training. Toddlers will also use this tactic during awake time, such as during a temper tantrum.

Medical:
Your baby could have a virus or some other medical issue causing the vomiting, so the first thing to do if your baby vomits during sleep training, is to rule out any medical issues. See a medical professional to rule out a virus, gastroesophageal reflux disease (GERD, or reflux), or some other medical condition that could cause vomiting.

If there is a medical cause, then you want to treat that first. During the time of treatment, you may decide to temporarily pause sleep training, or move back a step in sleep training to a point that your baby will be calmer during the process. I personally suggest pausing sleep training if your little one has caught a virus, as sleep training can prove difficult during this time as your baby will often need more sleep than usual or their sleep may disrupted.

If no medical conditions are present, then the vomiting from crying is behavioural. In this case, read on for ways to prepare for the potential of vomiting and how to respond.

Preventing Vomiting During Sleep Training

Make Positive Associations with the Crib

There are things you can do to help your baby or toddler feel more comfortable in their crib, which in turn may help reduce tears, thus reducing the chance of your baby vomiting during sleep training.

During the day, when your baby is wide awake and in a good mood, try playing in and around their crib several times a day. You can have the play last about 5-10 minutes each time.

During this play time you can place your baby in the crib along with a favourite toy, or you can read a book, play pee-a-boo through the bars of the crib, sing songs, anything that gives them positive feelings in their crib. As they start to get comfortable doing this, you can practice leaving them in their crib for a few minutes. So long as they are wide awake, not close to sleep time, and are in a good mood, try leaving them with their favourite toy in the crib while you run to the washroom, or grab something from another room. Leave their door open and the lights on during these few minutes. Over time this should help them develop positive associations with the crib.

Preparation

If your baby vomits while in their crib, you want to be able to clean up as quickly as possible, so not to make things over stimulating for your baby. In order to do this you will want to layer the crib sheets with protective barriers in between. This would look something like:

Mattress protector on the mattress
Crib sheet on top of mattress protector
Another mattress protector on top of the crib sheet
Another crib sheet on top of the second mattress cover

You may choose to stop there with 2 of each cover or you can choose to add a third mattress protector and crib sheet. This also helps with diaper leaks during the night. It allows you to quickly and quietly remove the soiled sheet to reveal a clean sheet underneath.

The second thing you should to do to prepare, is to leave out a set of clean pjs, sleep sack and wipes for quick changing and clean ups.

More ways to prevent vomiting during sleep training

Adjust feeding practices:
If overfeeding is a concern, ensure you're following appropriate feeding guidelines for your baby's age. Avoid feeding them immediately before sleep. Move their bedtime feeding up by at least 30 minutes or more. Have the feed take place at the start of the bedtime routine, such as before bath time (if that is the first step in your routine). Burping your baby after each feed can also help prevent excess gas.

Optimize sleeping conditions:
Ensure your baby's sleeping environment is conducive to comfort and safety. Use a crib or bassinet with a firm flat mattress and ensure they are placed on their back to reduce the risk of sudden infant death syndrome (SIDS). According to the NIH, “When on their back, baby’s trachea or windpipe (tube to the lungs) lies on top of the esophagus (tube to the stomach). Anything regurgitated, refluxed, or spit up from the stomach through the esophagus has to go against gravity to get to the windpipe and cause choking. When on the stomach, such fluids leave baby’s esophagus and pool at the opening for the windpipe, making choking more likely.”

Use a white noise machine to help calm and soothe your baby. White noise also becomes a great cue that it's time for sleep. Have blackout curtains in the windows so the room is very dark and keep the room at a temperature between 18-21 degrees Celsius (64-70 degrees fahrenheit).

Choose a Gentle Sleep Training Method:
Make the changes gradually or choose a gentle sleep training method that allows you to stay in the room with your baby during the sleep training process. During the process, try to keep them calm enough to not vomit but not calm enough to put them to sleep. The goal is for them to fall asleep on their own.

If you think your baby is getting to the point of vomiting, try soothing them with your voice or touch, shhhhing, whispering encouraging words such as "I'm here and you are ok and safe. I love you. It's ok to go to sleep." You can try singing or humming quietly as well.

Keep Calm:
You also want to keep calm during this time, which can be difficult when your baby is crying. Try taking a few moments for yourself to do some deep breathing. Remember, the more calm you are, the more it will help your baby to be calm.

If you are losing patience or are finding it difficult to stay calm, try trading off with your partner. Have them take over for a few minutes or until baby is asleep.

How to respond if your baby vomits during sleep training

Regardless of which method you chose to use, vomiting may still occur. While it can be distressing to witness your baby vomit during sleep training, it's important to remain calm and take the following steps.

Dos

Turn on a dim nightlight:
You want dim light, just enough to see what you are doing but not a full bright light as that will wake the baby too much. I suggest red light as it is less stimulating.

Comfort your baby:
Without talking too much, as that can give positive reinforcement for vomiting, you can quietly whisper soothing words. Reassure them that they are safe and loved. You must remain calm the entire time.

Observe for signs of distress:
If your baby appears distressed, check for any potential issues that may require immediate medical attention. Look out for signs of dehydration, severe discomfort, or abnormal breathing.

Clean up the mess:
Do your best to do the clean up without removing your baby from the crib as that will start a positive reinforcement for vomiting. Move your baby to a clean area of the crib, wipe their face and hands gently. Change their sleep sack or pjs, if needed, while still in the crib, if possible. As you clean them, use a gentle voice and touch to soothe them and reassure them everything is ok. Now you can remove any soiled bedding. Start at the corner closest to the vomit and remove the crib sheet and mattress protector. Roll it onto itself until you have space to move your baby onto a part of the clean sheet beneath. Roll the remainder of the sheet and remove it completely. You may also have your partner help you by having them clean up baby and you strip the bedding, so that it goes quicker. Do this clean up with as little interaction as possible. Give them a sip of water to rinse their mouth, if needed.

Once all cleaned up, give them a quick hug and kiss, reassure them with some soothing words, then lay them back down. Continue on with the sleep training method you have chosen. For example, if you are using chair in the room, go back to sitting on your chair.

Assess the situation:
Consider the circumstances leading up to vomiting. Was your baby overfed? Did they have a reflux episode? Identifying potential triggers can help you make adjustments to minimize the chances of it happening again.

Seek medical advice if needed:
If your baby continues to vomit excessively or shows signs of distress, it's important to consult your pediatrician. They can assess your baby's overall health, address any underlying medical conditions, and provide guidance tailored to your baby's specific needs.

Don’ts

Turn on the lights:
Turning the lights on will wake up baby more and cause overstimulation. This will not help them settle back down afterwards. As stated above, use a dim nightlight if needed, preferably red light as it is less stimulating.

Make a big production:
Remember, you want the interaction after vomiting to be minimum. Making a big production of it and taking baby out of the crib or room, giving them a bath, etc. will stimulate them too much and they won't be able to be calm enough to sleep. This can also create more vomiting as babies or toddlers can learn quite quickly to vomit to get their way if you give it a lot of attention. You do not want to give incentive for this behaviour to continue, as it can then trickle into awake time when they don't get their way in other situations.

Reefed:
As mentioned above, feeding too close to sleep can cause vomiting during crying, so the last thing you want to do is re-feed your baby as this will only cause your baby to vomit again.

Conclusion

While it can be concerning to witness your baby vomit during sleep training, it's essential to understand that it's a relatively common occurrence. By remaining calm, addressing the immediate needs of your baby, and implementing preventive measures, you can navigate this phase more confidently.

It can take up to 2 weeks for your baby to adapt to their new sleep routine. So long as you are consistent in your sleep training method and how you respond during it, your baby will settle into the new routine once they understand the cues you have given them. After a few days of being consistent with your sleep training method, your baby will start to learn the routine and cues so they will know what will happen leading up to naps and bedtime. You may even see the crying lessen and the vomiting stop within a few days of consistency.

Remember, each baby is unique, and if you are struggling to figure out how best to sleep train your baby and find the right routine for them, seeking guidance from me can provide you with personalized advice to help you and your baby achieve successful sleep training.

If you would like one-on-one coaching from me, book a FREE sleep assessment call today, or simply check out my services to view the packages I offer. If you see one you know you want, purchase that sleep package now and we can get started tomorrow!

Understanding and Managing Vomiting During Sleep Training