Sleep and Restlessness

Sleep Like a Baby

‘’Sleep like a baby’’.  Really? Surely the persons who coined that phrase were never parents, up hours on end trying to sooth a newborn, teething infant or cranky toddler.  Night waking and other sleep issues are among the most talked about topics during pediatric visits.  Books on sleep strategies for infants and children cram both the virtual and physical bookshelves.

The first acknowledgement that must be made is the fact that babies sleep differently than adults. Newborns under four months of age spend over half their sleep time in REM sleep, compared with the 25% that REM sleep comprises in the adult cycle.  As a result, newborns are noisy and move around at night.  Their sleep cycles are shorter, 60 minutes versus the 90 minute adult cycle.  This means that once per hour, they come to a ‘partial awakening’ and may whine or cry out briefly when this occurs.  Finally, newborns sleep about 16 to 18 hours per day—in 4 hour stretches!

What does this mean for you in the middle of the night?  First, remember that your infant will move around a lot at night and make noises frequently.  That doesn’t mean that your little darling is awake.  Wait briefly before responding to your infant’s stirrings.  He or she may reasonably go back to sleep after a brief awakening.  However, routinely don’t let your newborn sleep more than 4 hours at a stretch, during the day or at night.  Remember that your infant’s nutritional needs are high at this critical point in his or her growth and development.  Newborns simply need to eat at least every three to four hours.  During the day, waking your infant after three hours may help to combat ‘day-night’ confusion.  Combat your own sleepiness during this brief period in your child’s life by keeping your own life simple.  Sleep when your infant sleeps.  Keep dinners simple and household chores to a minimum.

By four to six months, many infants will begin to need less sleep, and to sleep in longer stretches.  However, their sleep patterns still are far from comparable to an adult’s sleep patterns.  They still may wake briefly during the night and it is often at this time that they have more difficulty transitioning to sleep.

Helping your child transition to sleep is a fundamental parenting task.  We will discuss further good bedtime routines below.  However, in infancy, it is important that your infant begin to fall asleep on his or her own.  Put your baby to bed when he or she is drowsy, but BEFORE your child is completely asleep.  Avoid the temptation to ‘feed them to sleep’ with a breast or bottle.  When your child wakes at night, walk (don’t rush!) to your infant and make the interaction as brief and as boring as you can. Again, wait until your child has been awake for a few minutes before responding.  When you first respond, resist turning on the light or picking up your child.  Change the diaper or feed as calmly, quickly and quietly as possible.  Settle your child back down and leave again, before your child is asleep.

Infants are often easily overstimulated and have a hard time self-soothing.  Strategies that calm your newborn may help them sleep.  Swaddling an infant under 4 months, sucking, swaying and singing are all good strategies to help your infant relax.  Avoid making things worse and contributing to the overstimulation by working too hard and stressing yourself out in the process.  Sometimes just rocking and holding your infant in a quiet, dark room is enough to do the trick.

Follow these steps right from the start, remember that this is a brief time in your child’s life and make sure you are taking good care of yourself and you will all be slumbering peacefully soon!

Infant sleep requirements:

Newborns to 4 months old:  14-17 hours out of every 24 hours

In general, younger newborns in the first few weeks of life sleep for multiple short stretches between feeds, and as they grow closer to 4 months they begin to fall into a pattern of several naps during the day and sleeping longer stretches at night.

4 to 12 months old:   12-15 hours per day, 2-3 naps per day

Older infants are usually able to sleep for longer stretches at night and generally have the skill set to self-soothe. For the most part they do not need to eat overnight.

Additional Resources from the American Academy of Pediatrics

How to Keep Your Sleeping Baby Safe: AAP Policy Explained

Safe Sleep Tips for Sleep-Deprived Parents

Suitable Sleeping Sites: Safe at Night & Naptime

For Sleep-Deprived New Parents, These “Gifts” Can Be Priceless

Healthy Children Podcast: Sleep: Teaching Good Habits Early