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As a pediatrician, one of the reasons I am becoming increasingly cautious about insensitively using the cry-it-out approach to get babies to sleep longer is that doctors and parents automatically assume that a nightwaking baby has bad sleeping habits and they miss underlying painful causes of nightwaking. Suspect a medical cause for nightwaking if:

• baby awakens with sudden colicky-type abdominal pains
• a good sleeper suddenly becomes a restless sleeper
• baby has not slept well since birth
• there are other signs or symptoms of illness
• baby cries inconsolably
• your intuition tells you something is wrong
• no other cause is apparent

Here are the most common painful causes of nightwaking and which are often "hidden" because they are not as obvious as ear infections, teething, or urinary tract infections.

When baby lies flat, irritating stomach acids are regurgitated into the esophagus, causing pain that adults call "heartburn." Mention this possibility to your doctor, since GER can often be successfully treated with smaller, more frequent feedings, elevating the crib 30 degrees, and medication. such as an allergy to formula or to the cow's milk breastfeeding mothers drink. Suspect if baby is restless most of the night and is generally gassy. Suspect an ear infection if baby has a yellow discharge coming from her nose and/or eyes. Suspect in the toddler or older child who is waking up with scratch marks around the anus, other family members have pinworms, or you see tiny white-thread-like worms around baby's anus or in the bowel movements at night.

Infants who awaken frequently because of a medical cause are also more likely to be colicky and fussy during the day, but not necessarily. If you suspect a medical cause, in partnership with your doctor, keep investigating until you find the cause and the treatment.