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The question: My baby only sleeps when we play music for him all night long. Will this cause him any harm, or creating a dependency that will be difficult to break down the road?

The answer: Your baby has developed a sleep association with the music. Some babies develop a sleep association with an object such as a blanket, stuffed animal or pacifier. Sleep can also be associated with habits such as being rocked to sleep or falling asleep while feeding. Older children can also have sleep associations such as drifting off while watching television or falling asleep with a parent.

Sleep associations are not always bad. For example, having a routine that helps your baby nod off can be very helpful in the first few months of life when frequent feedings and nighttime awakenings are the norm. The best sleep associations don't directly involve a parent, so that when the infant awakens in the middle of the night, they fall back asleep (for example with their blanket or soother) without needing to wake the parent.

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The tricky part about sleep associations is that they can be habit forming and challenging to break. Waking up every three hours to feed and rock your two-month-old back to sleep is expected, but having to do the same thing with your four-year-old can be tiring and frustrating.

Some sleep associations are particularly problematic. Thumb and finger sucking is an almost impossible habit to break later on and can have serious repercussions for teeth and palate, as well as the thumb and fingers. Thumb sucking should be discouraged as soon as it is discovered – a pacifier is preferable to the thumb as it is an easier habit to break. Falling asleep with a bottle of milk is also problematic. Not only are there significant nutritional and dental complications, but it also involves a parent waking up through the night to administer feedings. It is normal for infants to fall asleep while feeding in the first six months of life. After about six months, however, it is preferable to stop the feeding before your baby drifts off.

There are many different methods for breaking sleep associations. Typically this involves leaving your child alone in bed until they learn to fall asleep by themselves. In my experience this is best accomplished between six and 12 months of age, although timing can vary depending on the personality of the child and the needs of the family.

Playing music while your baby falls asleep is not harmful and is unlikely to be a major problem unless you have to get up through the night to turn the music back on. Eventually, you may want to play music for your child at bedtime only, turning the music off when your child gets sleepy and allowing your child to fall asleep on his own.

Send pediatrician Michael Dickinson your questions at pediatrician@globeandmail.com. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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