Infant Sleep: Advice from an Expert

Local Certified Sleep Consultant Tara O’Mahony answers questions about sleep during baby’s first year of life.

Q: In general, define healthy sleep for infants 0-12 months.

A: When I am working with clients, I help them to understand that healthy sleep is defined as the correct amount of age-appropriate sleep, at the correct biological time, and for the correct, consolidated length. Parents are often surprised at how much sleep a baby needs in the first year of life.

Some general guidelines as to how much sleep the average child needs in the first year of life are:

• 0-2 Months: Total Sleep, 16-18 hours, including 3-5 naps, and 2-4 night feedings
• 2-4 Months: Total Sleep, 14-16 hours, including 3-4 naps, and 2-3 night feedings
• 4-6 Months: Total Sleep, 14-15 hours, including 2-3 naps, and 0-2 night feedings
• 6-9 Months: Total Sleep, 14 hours, including 2-3 naps, and 0-1 night feedings
• 9-12 Months: Total Sleep, 14 hours, including 2 naps, and 0 night feedings

During the first year of life, a baby will go through several sleep milestones, many of them occurring in the first four months. Understanding when these milestones occur and how they affect a baby’s ability to sleep, and sleep independently, will help parents get their baby the sleep he or she needs to thrive.  Also, parents should keep in mind that a baby’s age is based on the child’s expected delivery date (EDD) and not on the day the baby was born.  So a child was born more then two weeks early will likely not hit sleep milestones until he or she reaches the specified ages based on the EDD.

Weeks 1-6:  The first days and weeks at home can be overwhelming for first-time parents and seasoned parents alike.  Spend this time getting to know your baby and do not worry about creating bad habits relative to sleep. Do whatever it takes, and is safe, to get the baby to sleep. That can be holding, rocking, wearing baby, letting him or her sleep in a swing or using a pacifier. Do not be surprised if your newborn can only stay awake for very short periods of time during the day in the first weeks at home.  Most babies will only be able to stay awake for 40 to 60 minutes, which is just enough time to feed, change a diaper and put them back down for their next nap. The goal is to try to keep your child as rested as possible.

Weeks 6-8:  The first sleep milestone occurs between 6 and 8 weeks after your child’s EDD. When  babies first start to smile socially when they see Mom and Dad, it signals that they are now able to follow cues and make connections. The social smile also coincides with the beginning development of night sleep. At around 6-8 weeks, night sleep becomes more organized and your baby should be able to sleep for 4- to 6-hour stretches. The day/night confusion that existed in the first six weeks of life ends and many babies will become fussy in the late afternoon or early evening.  This is the perfect time to start establishing a healthy foundation for sleep.

Some of the key things to try at this age are:

• Begin having your baby sleep in a consistent sleeping place for naps and at night. Introduce your baby to sleeping in his or her crib and reduce the use of the swing, bouncy seat, stroller and car at sleep time. Sleeping in motion is not as restorative as sleeping in a stationary location.
• Develop a bedtime routine that will signal to your baby that the day has ended. The bedtime routine does not have to be elaborate and can include a bath but does not have to. Four to five simple steps done in the same order each night help the baby transition from the activity of the day to longer periods of sleep at night. A bedtime routine could be a final feeding or bottle, change into a night-time diaper and PJs, a song and/or a short book, hugs and kisses, swaddle or sleep sack and into the crib. The routine should take place in the baby’s room or the parents’ room if the crib is located there. As bedtime approaches, keep the lights low to help signal to the brain to produce melatonin, the sleep hormone.  Condense your bedtime routine at naptime to calm your baby before the daytime sleep.
• This is the time to also start giving your baby the chance to self-soothe. When nap or bedtime comes, start trying to put your baby down awake and give her a few minutes to self-soothe. If the baby struggles pick her up and comfort her, and when she becomes calm, put her down again to see if she can get herself to sleep. After one or two pick-ups and put-down attempt, if she is still struggling, return to what you have done in the past to aid her to sleep. Continue to give her the opportunity to self-soothe each day. Some babies will quickly learn to put themselves to sleep, while others will not acquire this skill for several more weeks.
• As night sleep develops neurologically, the bedtime will naturally move earlier. If you find that your baby is fussy in the evening between 6 and 8 p.m., this is an indication that this is now his bedtime. Honor a baby’s need to go to sleep earlier as the most restorative phase of night sleep occurs between 6 p.m. and midnight.  The more sleep your baby can get in the early part of the night, the better he will sleep in the early morning hours.

Months 3-4: Between 3 and 4 months, your baby should be able to stay awake for 60 to 90 minutes between naps. Some of the naps may be becoming longer. This is because at around 4 months of age, day sleep begins to organize in the brain. Many parents call this development the 4-month sleep regression because night sleep can start to get worse for a period of time. I explain this period of development to my clients as the 4-month sleep awakening. With day sleep organizing, your baby should now be sleeping during specific times of the day called sleep waves. These sleep waves are controlled by our circadian rhythms, which until approximately 16 weeks of age are not fully mature. Once a baby hits this sleep milestone, a more consistent daytime schedule can emerge. If your baby does not naturally fall into a regular napping schedule at around 16 weeks of age, then you can begin to nap him more in line with the biological sleep waves, using the clock as a guide, rather then using sleepy cues to determine nap times. If your baby’s night sleep had regressed, once he starts taking naps at the most restorative times and for a consolidated length, the night sleep should begin to improve. From this age forward, babies will benefit from napping by the clock and going to bed a little earlier then before, between 5:30 and 7 p.m. Many babies, whether breast or bottle fed, can sleep through the night (11-12 hours) at this age.

Q: What can parents do to help their infants get better sleep?

A: The number one thing I tell parents to keep in mind is Sleep equals Sleep. A baby who is well rested throughout the day will sleep better at night, and a baby that sleeps well at night will take better naps during the day. A young baby cannot sleep too much. As long as the baby is eating well, do not worry if your newborn sleeps the majority of the day and night. Consult with your pediatrician as to how often your baby needs to eat and wake him or her should the child still be sleeping at that time.

The principle of Sleep equals Sleep continues to be vital to keeping babies rested through their young lives.

The other key element that will help babies sleep better at night is to honor an early bedtime. Babies and toddlers are very sensitive to light during the day and the lack of light at night. As the sun sets, it signals to the baby’s brain that night sleep is upon them and we need to respect that to keep little ones rested. For these reasons, I recommend a bedtime between 5:30 and 7 p.m. for children under 36 months of age. Parents then worry that if they put their babies or children to bed in line with their bio-rhythms that they will wake very early for the day. A biologically appropriate wake time for most babies is between 6 and 7 a.m. It may seem counter-intuitive, but an earlier bedtime does not result in an earlier wake up. In fact, it is often the reverse; the earlier we can put our children to bed, the later they will sleep in the morning. It is not logical; it is biological.

Q: What About Crying it Out?

A: One of the most common questions I get from parents looking to improve their child’s sleep is, “How much crying will there be?”  The obvious answer to this question is that every child is different and every family situation is different, so it will vary greatly how much a child will cry.

It is realistic to expect that if your baby has been dependent on a sleep association (i.e. rocking, feeding, being held), he or she will protest once that association is removed and the baby learns to self soothe and fall asleep independently. Other factors that can influence how much crying is involved during the learning process are the following: the baby’s age, the baby’s personality, the quality of the daily and nightly routine, whether or not there have been previous attempts at sleep training and, finally, the method of sleep training that is chosen.

When I work with families, I explain the pros and cons of the different methods of sleep training and allow them to choose the method they think will work best for their child and with which they feel they can be consistent. Many of the parents who come to me for help have tried numerous ways to get their baby to sleep better but to no avail. In their sleep-deprived state, they have become very inconsistent in how they get their baby to sleep at naptime, bedtime or in the middle of the night. As in most parenting decisions, consistency is the key to teaching or changing any behavior. Once a sleep-training method is chosen, I support the parents to make sure that they are being 100 percent consistent in its implementation, which leads to a faster learning curve for the baby and less crying overall.

Q: How can a sleep consultant help infants (and their parents) get better, healthier sleep?

A: For families that are struggling to get their baby to take restorative naps and sleep for long, consolidated periods at night, working with a certified sleep consultant can be of great benefit.  Sleep is not only essential for a baby to grow and develop, it is necessary for Mom and Dad to function inside and outside the home. A sleep consultant is part educator, part coach and part cheerleader.  When I work with a family, I provide them with some of the key information about the science of sleep so that they better understand the recommendations I am making. I coach them through teaching their child to self soothe and getting the child to take restorative naps, have an age appropriate bedtime and sleep through the night.

Teaching your baby to sleep is a process that can have ups and downs and that is where the cheerleader element comes in. I am there to cheer the baby’s sleep victories and encourage the parents should they get discouraged during the process. In the end, the goal is for the whole family to be getting the sleep they need.

Tara offers a free 15-minute consultation for parents interested in learning more about her services. Contact her at tara@goodnightsleepsite.com. Visit www.goodnightsleepsite.com for more information.