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If you’ve been a parent for longer than 24 hours, you know the expression “sleep like a baby” is a big, fat lie. Babies don’t sleep soundly, like, at all. They grunt and groan, cough and sigh, scooch and squirm and wiggle.

But what you might not be expecting as a new parent is for your baby to wake up crying hysterically in the middle of the night. How does your baby go from zero to 60 like that — and, more importantly, why?

The reason for hysterical midnight wake ups depends largely on your baby’s age.

Newborns often wake up for totally different reasons than 4-month-olds, for example. And 9- to 12-month-olds? They’ve got a whole other set of concerns.

If your nights are punctuated by the sudden screams of your formerly peaceful little babe, here’s why it might be happening — and what you can do about it.

Babies are way more prone to these alarming nighttime disturbances than adults are — mostly because there are a ton of reasons why they might happen. Here are the most common:

  • hunger
  • gas
  • teething
  • uncomfortable environment
  • sickness
  • separation anxiety
  • sleep regressions
  • growth spurts
  • nightmares or night terrors

Let’s take a closer look.

Hunger

If your baby is under 4 months old, the biggest reason for hysterical, middle-of-the-night wake ups is hunger, says Dr. Natasha Ahmed, pediatrician at Austin Regional Clinic in Austin, Texas.

And very young babies eat around the clock, every 2 to 3 hours.

Eventually, your baby will drop some night feedings and go longer amounts of time in between. At this age, though, needing to be fed is probably the cause, especially if it’s been a few hours since their last feeding.

Gas

Your baby eats a lot (as we noted above!), but their digestive system is also not fully developed yet.

Even if they don’t have an intolerance to cow’s milk, for example, their tummies still aren’t always great at breaking down the things they’re exposed to in breast milk or formula.

This leads to gassiness, which leads to pain and discomfort. And because your baby is basically a tiny, helpless human, they don’t know how to relieve themselves of gas symptoms (so they need your help).

If your baby has a lot of flatulence or seems to be scrunching up their midsection, they could be dealing with painful gas.

Teething

Between the ages of 4 and 6 months, says Ahmed, the start of teething is a common reason for nighttime wakings.

Though teething pain can last for months, eventually your baby will learn how to cope. At this age, however, they’re going to be fairly distressed by that achy, itchy sensation in their mouth.

Some common signs of teething include:

  • excessive drool
  • baby wanting to put literally everything into their mouths
  • swollen gums

If your little one is showing any of these signs during the day and having pain-fueled wake ups at night, teething is probably to blame.

Uncomfortable environment

A poopy diaper, a too-hot or too-cold room, a pee-soaked fitted crib sheet — if it would be uncomfortable for you to sleep in, it’s probably uncomfortable for baby to sleep in.

Again, because babies can’t solve any of their own problems, they’ll be sure to let you know (sometimes in the loudest, angriest way possible) that their sleep is being disrupted by something in their environment.

Sickness

When illness strikes in the middle of the night, your little one could wake up suddenly with a fever, a stomachache, or congestion.

If your child feels hot, check them for a fever. If they seem inconsolable or are rubbing or tugging at their ears, eyes, or nose, they could be trying to tell you they’re not feeling well.

Separation anxiety

In older babies — around 9 months and up — waking up during the night begins to become more of a developmental issue than a physical one.

“From about 9 to 12 months, it’s [probably] separation anxiety,” says Ahmed. “It’s common for babies this age to wake up, realize Mom or Dad isn’t around, and lose it.”

If your baby wakes up screaming but then calms down the minute you race to their bedroom, you’re most likely dealing with an emotional need, not a dirty diaper or empty belly.

Sleep regressions

Ah, sleep regressions. The worst part of parenting that no one tells you about!

There are several developmental stages when sleep regressions are likely to occur. These include in months 4, 6, 8, 12, 18, and 24.

The thing all these stages have in common is that they mark some sort of developmental milestone in your child. Whether they’re becoming more independent, trying to assert their wants, or simply missing you, developmental changes often lead to sleep regressions.

In babies under 1 year old, the main reason for a sleep regression is the attachment to a bedtime routine or what experts call sleep props.

“If [your baby has] consistently been put to bed with a bottle or pacifier and wakes up to realize it’s not there anymore, they’ll start screaming,” says Ahmed.

The same goes for anything you do to help your child fall asleep, like rocking, feeding, or snuggling.

If your child depends on someone or something to nod off, when they inevitably wake up during the night between sleep cycles to find themselves alone in a dark crib, they’re going to be pretty alarmed.

Growth spurts

Younger babies go through periodic growth spurts that make them ravenous, insatiable beasts. (OK, it just makes them extra hungry, but still.)

That means not only might they wake up more often during the night to feed, they might request those feedings awfully urgently.

A true growth spurt typically lasts only about 2 or 3 days. If your young baby is waking up crying and nothing but feeding soothes them, it’s possible the situation is temporary and will resolve on its own.

Nightmares or night terrors

Though most common around 3 to 4 years old, nightmares or night terrors can definitely disrupt a baby’s sleep and leave them crying — hysterically — for you during the night. But most babies won’t begin having night terrors until 18 months, so if your baby is younger than that, it’s probably not the cause.

Younger babies are, however, prone to an overactive startle reflex that can often look like they’ve woken up from a bad dream.

“Babies will startle themselves awake between sleep cycles,” Ahmed says, “and it just takes a pat on the back or a physical touch to help them back to sleep.”

When your baby wakes up suddenly crying at night, there are a few quick steps you can run through in an attempt to figure out what’s wrong (because you can’t solve the problem if you don’t know what it is!):

  • See if their basic needs have been met. Ahmed suggests checking off boxes in your head: Has your baby been fed? Changed? Do they feel warm or cold? Sometimes the solution is as simple as feeding your baby, changing their diaper, or swaddling them again.
  • Try to assess if they’re in physical pain. If your baby has been chewing on everything during the day, they’re probably teething — and a little gum massage or age-appropriate dose of Tylenol might help. If they seem gassy, Ahmed recommends doing some bicycle kicks or even giving some gas drops — but check with your pediatrician.
  • Gauge your older babys emotional response to you showing up in their bedroom in the middle of the night. If they’re happy to see you, they probably have separation anxiety. If they settle down as soon as you pick them up or pop the paci back in their mouth, they’ve likely become dependent on a sleep prop.

“If [all of] baby’s basic needs are met, then it’s likely they need to develop some self-soothing behaviors for themselves,” Ahmed explains.

If you suspect your baby needs to learn how to fall back to sleep on their own (or just exist without you for a few hours, because they’re a stage 5 clinger), we have some good news and some bad news.

The good news is that this problem has a solution. The bad news is that it’s sleep training. (We know, we know — no one wants to sleep train their baby. It sounds difficult and exhausting and stressful.)

We won’t get into the nitty gritty of how to sleep train here, because there are a lot of methods (including gentle ones… It’s not all cry-it-out!). It’s also just not right for every family.

But if your child has developed an attachment to a routine, a person, or an object to happily fall asleep — and they’re waking up in the middle of the night because they don’t have it anymore — the cold, hard truth is that sleep training is a viable solution.

“If you’ve tried consistently for 2 weeks to soothe your baby back to sleep and you’re not making any progress, it’s reasonable to consider a more formal sleep training approach,” advises Ahmed.

FYI, sleep training typically doesn’t help babies under 4 months old, so you can’t jump into it too early. It also can take some time to work.

Ahmed notes that it takes 2 weeks to both form and break habits, so you’ve got to be willing to stick with your sleep training plan for a little bit before declaring it’s “not working.”

“I would stress patience,” Ahmed says. “A lot of the time when babies are crying in the middle of the night, there’s nothing you can do [to fix it], it’s a matter of waiting it out, being patient, and staying the course.”

For the most part, all of these sleep concerns are ones you can resolve at home. It might not be easy to do so — and sometimes the answer simply isn’t that obvious — but nighttime wakings are not typically something that requires a doctor’s visit.

That said, if your baby seems ill, isn’t eating or peeing normally, or has a temperature of 100.4°F (38°C) or higher, Ahmed says you probably should check in with your doctor. Same goes for babies who are crying inconsolably night after night with no apparent cause.

Of course, you’re always welcome to call your doctor at any time for tips, advice, or even to schedule a “just in case” appointment to rule out physical issues that could be waking up your baby at night. That’s what they’re there for, and they’ve seen it all.

Babies wake up during the night for all kinds of reasons, most of them totally typical and not serious.

Babies under 6 or 9 months of age usually have physical needs, like hunger or teething, while babies over 9 months are more prone to developmental disruptions, like separation anxiety.

Knowing what’s causing your baby’s arousals is the first step in learning how to help them have fewer wake ups.

While most concerns can be solved with time and patience, if you’re unsure what’s going on or your baby seems sick or in pain, you can give your doctor a call for more help.