Overview: Baby sleep

sleep and babiesBabies normally sleep 12-18 hours a day. Newborn babies may sleep up to 18 hours a day. Infants (1-3 months) sleep ~14-15 hours a day. When we refer to problems with baby sleep we mean persistent night-waking by some babies who really don’t need to wake up (for milk or for medicine or for reassurance in a strange place) but who do it anyway.

Good sleep is vital at any age. In babies, who have the greatest need for sleep, it is thought to drive development of the brain processes that evaluate new daytime events and create new skills. Babies’ sleep is also important for energy restoration, physical growth and immune systems as well as many other basic body functions. Furthermore, behavioral and social development depend on satisfactory sleep. Otherwise babies may be irritable, generally out of sorts and not functioning well. Basically the consequences are very similar at any age.

Unfortunately parents are often not taught about sleep and ways of preventing their children’s sleep problems. Also, professionals involved in child healthcare do not learn much about these topics in their training. As a result, many babies fail to sleep enough and/or learn bad sleep habits which may persist into later life. It certainly doesn’t help that parents themselves are sleeping all too little and are chronically tired.

The size of this problem is significant. According to Professor Gregory Stores about a quarter of families are significantly affected by their young children’s sleep problems. He also wants to emphasize that sleep problems can be effectively treated with many children.

The most common problem with newborn babies (who usually sleep ~16hours per day) is that parents’ own sleep is disturbed by the repeated need to feed the baby in the night. Newborns have not yet developed their internal body clock that controls the pattern of sleeping and waking. For this reason they wake up about every 2-4 hours, usually when hungry. Gradually the longest sleep period increases and by 6 months a person’s body clock is sufficiently matured to enable good, continuous night sleep.

It is important to encourage good sleep patterns from early on to avoid bad sleep habits later on, such as bedtime problems and difficulties during the night.

Sleep guidance for babies and their parents

There are hundreds of different guidelines to make your baby sleep. Most experts agree on few things. Firstly, from six months, children should be able to fall asleep on their own until morning. Secondly, if they associate cues such as TV, being rocked or being cuddled, with sleep they fail to learn to sleep on their own. The following ones focus on guidance that is helpful for both the babies’ and their parents’ sleep.

Baby sleep guidance by Dr Gregg D. Jacobs:

1. Expose infants to bright light, activation and stimulation during the day and darkness and quiet at night. As infants get older, shorter the length of their daytime naps by gently waking them.

2. Introduce a quiet wind-down period before the bedtime. This period should be enjoyable, predictable and consistent and involve activities such as reading, singing lullabies and turning down the lights.

3. Make sure the infant’s room is sufficiently quiet and dark at night. Gradually reduce the frequency of nighttime feedings and lengthen the time between them. Most babies don’t require nighttime feedings after 6 months.

4. Enable your baby to learn to fall asleep on his/her own. Put infants in the cot before they fall asleep so that they learn to associate the cot with falling asleep. Similarly, a child who awakens during the night should learn to fall back to sleep in the cot. Be careful about letting a nursing baby fall asleep on the mother’s chest: with such warm and comfortable place to sleep, it is easy to understand why the baby will not learn to sleep in the cot.

5. An infant who cries at bedtime or during the night needs to be comforted. However, at about 3-6 months of age, the infant should be taught to fall asleep on his/her own instead of depending upon a bottle, being held or sleeping in parents’ bed.

Baby sleep guidance by Dr Richard Ferber:

1. If a baby cries at bedtime or after nighttime awakening, let the child cry for five minutes. Then go into the baby’s room reassure the baby by talking softly, and leave the room. Don’t reinforce the baby’s crying by picking the baby up, massaging or patting the baby or spending more than a few minutes in the room.

2. If the baby continues to cry, let the crying continue for 10 minutes, then return to the room. Reassure the baby without picking him/her up, then leave the room quickly. If the baby continues to cry, return to the bedroom after 15 minutes of crying. Subsequent checks should be after an additional 15 minutes of crying.

3. The following night, the first check should be after 10 minutes of crying; second check after 15 minutes; and subsequent checks after 20 minutes. For each successive night, add 5 minutes to the length of the first and subsequent checks.

With this method most babies learn to fall asleep on their own within a week (it sometimes takes the parents that long to get comfortable with the idea of letting the baby cry for the more than a few minutes). In some instances, the baby may cry as much as an hour or two the first or two nights. However, the duration of crying usually diminishes every night. The key to succeeding with Ferber’s approach is consistency and willingness to lose some sleep the first few nights.

TIP: As infants get a bit older, it’s a good idea to let them sleep with a stuffed animal or something soft (like blanket). Over time, the child will learn to associate falling asleep with the animal or soft thing.

Baby sleep guidance by Dr Gregory Stores:

1. Establish a 24-hour routine. Keep this daily routine as consistent as circumstances allow.

2. Introduce a bedtime routine. Routines are important signals to your baby that it is time to go to sleep soon. Bedtime routines can involve the following things: bathing, changing night clothes, feeding, a cuddle, pulling the curtains, a lullaby, kissing, saying goodnight.

3. Allow your baby to learn to sleep alone. To help your baby become self-soothing, put him/her in a cot when awake or drowsy and then leave him/her to fall asleep alone. If he/she cries, wait a few minutes rather than responding immediately. Note: crying doesn’t necessarily mean your baby is hungry.

4. Don’t continue nighttime feeds after 6 months. Feeding beyond this point can get in way of establishing good sleep patterns. The solution is gradually to reduce nighttime feeding and then stop. This can be effective in as short a time as 2 weeks or so.

5. Establish a clear difference between day and night. This way you help to develop the baby’s body clock and he/she will learn that at night it’s dark and calm and during the daytime it is bright and active.

6. Create a convenient sleep environment for the baby. This means the right temperature, quiet and/or well lit.

Note: These various practical guidelines will not be effective if your children suffer from physical disorders such as cow’s milk allergy or a painful ear infection or colic.

Useful links to help a baby sleep

Sleep training is all about teaching your baby to settle himself/herself back to sleep when he/she wakes at night, rather than relying on you to wake up and help him/her out. And you do this either by ignoring him/her completely when he/she wakes or by responding to him/her in a particular (and rather lukewarm) way.

Sleep support with kids: Cry-sis helpline on 08451 228669 (9am to 10pm, seven days a week)

Babycentre UK

Mumsnet newborn baby advice

NHS helping your baby sleep well

3-days sleep training

The sleep sense program

Interesting! Why do Finnish babies sleep in cardboard boxes? The maternity package - a gift from the government – is available to all expectant mothers. Finland also enjoys one of the lowest infant mortality in the whole world. Something to copy elsewhere?

References & Disclaimer

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